ABOUT THE SPEAKER
Elizabeth Pisani - Author
In Elizabeth Pisani's latest book, she explores the "improbable nation" of Indonesia.

Why you should listen
In fast-emerging Asia there is one nation that, despite being the world's fourth most-populous (and the third most-populous democracy) and the largest Muslim country (with 210 million people who identify themselves as such), is also, as Elizabeth Pisani writes, "probably the most invisible country in the world". Indonesia. An archipelago of over 17,000 islands that span a distance like that from New York to Alaska, with over 700 languages and a dynamic economy -- but which, puzzingly, doesn't really feature in the global imagination.

Pisani spent two years travelling 23,000 kilometers by boat, bus and motorbike through Indonesia, a place that has fascinated and maddened her since she first lived there over two decades ago. Her portrait of the country, the recent Indonesia Etc.: Exploring the Improbable Nation, reveals the archipelago's complexity and contradictions, a fascinating diversity that "is not just geographic and cultural: different groups are essentially living at different points in human history, all at the same time."

An alumna of various government health agencies, Pisani became an assumption-busting independent researcher and analyst, polling transgendered sex workers, drug addicts and others to illuminate the surprising (and often ignored) demographics that belie traditional studies.

Pisani is fearlessly outspoken on the global failure to understand and manage the realities of AIDS, decrying the tangled roles that money, votes, and media play in the public health landscape. She shows how politics and "morality" have hogtied funding, and advocates for putting dollars where they can actually make a difference. As the Globe and Mail wrote: “Pisani is lucid, colourful, insightful and impatient.”

More profile about the speaker
Elizabeth Pisani | Speaker | TED.com
TED2010

Elizabeth Pisani: Sex, drugs and HIV -- let's get rational

伊莉莎白·皮薩尼談性、毒品、愛滋病病毒HIV--讓我們理性點吧!

Filmed:
1,494,475 views

有著極為有力的邏輯論點、智慧以及獨特的公共衛生檢視鏡,伊莉莎白·皮薩尼揭露了現今政治體系下所產生的無數矛盾。這些政治決策,讓我們大眾的金錢無法有效運用在阻止愛滋病病毒的傳播。她針對愛滋病高危險群做出了研究--從獄中的毒癮者到柬埔寨街上的性工作者--說明了有時和人們直覺大相逕庭的政策反而會有效地阻止可怕的愛滋病蔓延開來。
- Author
In Elizabeth Pisani's latest book, she explores the "improbable nation" of Indonesia. Full bio

Double-click the English transcript below to play the video.

00:16
"People do stupid things.
0
1000
2000
「人們會做蠢事,
00:18
That's what spreads利差 HIVHIV."
1
3000
2000
愛滋病就這樣傳播開來。」
00:20
This was a headline標題 in a U.K. newspaper報紙,
2
5000
2000
這是不久前英國報紙
00:22
The Guardian監護人, not that long ago.
3
7000
2000
《衛報》的頭條標題。
00:24
I'm curious好奇, show顯示 of hands, who agrees同意 with it?
4
9000
3000
我很好奇,有誰同意這句話? 舉個手吧!
00:29
Well, one or two brave勇敢 souls靈魂.
5
14000
2000
嗯,有一兩位,真是勇敢。
00:31
This is actually其實 a direct直接 quote引用 from an epidemiologist流行病學家
6
16000
3000
這句話出自一位流行病學家,
00:34
who's誰是 been in field領域 of HIVHIV for 15 years年份,
7
19000
2000
她研究HIV已有15年,
00:36
worked工作 on four continents大陸,
8
21000
2000
足跡遍及四大洲,
00:38
and you're looking at her.
9
23000
2000
這個人就是我
00:40
And I am now going to argue爭論
10
25000
2000
我想說的是,
00:42
that this is only half true真正.
11
27000
2000
這句話只有一半是真的。
00:44
People do get HIVHIV because they do stupid things,
12
29000
3000
有些人的確是因為做了蠢事而感染HIV,
00:47
but most of them are doing stupid things
13
32000
2000
但其中大部分的人做出這些蠢事
00:49
for perfectly完美 rational合理的 reasons原因.
14
34000
3000
是有完全合乎理性的原因
00:52
Now, "rational合理的" is the dominant優勢 paradigm範例
15
37000
3000
現在,理性在公共衛生上
00:55
in public上市 health健康,
16
40000
2000
是首要的準則。
00:57
and if you put your public上市 health健康 nerd書呆子 glasses眼鏡 on,
17
42000
3000
如果你戴上了愚蠢的公共衛生檢視鏡,
01:00
you'll你會 see that if we give people the information信息 that they need
18
45000
3000
你將會看到若我們提供人們所需的資訊,
01:03
about what's good for them and what's bad for them,
19
48000
2000
告訴他們什麼對他們是好的,什麼是不好的,
01:05
if you give them the services服務
20
50000
2000
或是我們提供服務,
01:07
that they can use to act法案 on that information信息,
21
52000
2000
讓他們可以根據所得的資訊來行動
01:09
and a little bit of motivation動機,
22
54000
2000
加上一點點動機,
01:11
people will make rational合理的 decisions決定
23
56000
2000
人們將可以做出理性的決定,
01:13
and live生活 long and healthy健康 lives生活.
24
58000
2000
並過著健康長壽的生活
01:15
Wonderful精彩.
25
60000
2000
棒極了!
01:17
That's slightly problematic問題 for me because I work in HIVHIV,
26
62000
3000
這對我來講是有點問題的,因為我在愛滋病領域工作,
01:20
and although雖然 I'm sure you all know
27
65000
2000
雖然我很確定你們都知道
01:22
that HIVHIV is about poverty貧窮 and gender性別 inequality不等式,
28
67000
3000
HIV關乎著貧窮還有性別不平等,
01:25
and if you were at TEDTED '07
29
70000
2000
如果你有參加2007年的TED,
01:27
it's about coffee咖啡 prices價格 ...
30
72000
2000
就會知道愛滋病也和咖啡的價格息息相關。
01:29
Actually其實, HIV's艾滋病病毒 about sex性別 and drugs毒品,
31
74000
3000
事實上,HIV和性交、毒品脫不了關係。€
01:32
and if there are two things that make
32
77000
2000
若有兩樣東西
01:34
human人的 beings眾生 a little bit irrational不合理的,
33
79000
2000
能讓人類喪失理智,
01:36
they are erections勃起 and addiction.
34
81000
3000
那就是勃起跟上癮。
01:39
(Laughter笑聲)
35
84000
2000
(笑聲)
01:41
So, let's start開始 with what's rational合理的 for an addict癮君子.
36
86000
3000
我們先看看對於一個癮君子來說,什麼是不合理的。
01:44
Now, I remember記得 speaking請講 to an Indonesian印度尼西亞 friend朋友 of mine, Frankie弗蘭基.
37
89000
3000
我記得我跟一個印尼籍的朋友聊天,他叫做法蘭克。
01:47
We were having lunch午餐 and he was telling告訴 me
38
92000
2000
我們當時正在吃午餐,他正在跟我分享
01:49
about when he was in jail監獄 in Bali巴厘島 for a drug藥物 injection注射.
39
94000
3000
在巴里島獄中注射毒品的經驗。
01:52
It was someone's誰家 birthday生日, and they had very kindly和藹
40
97000
2000
那一天是某個人的生日,他們很體貼地
01:54
smuggled走私 some heroin海洛因 into jail監獄,
41
99000
2000
走私了一些海洛因到獄中。
01:56
and he was very generously慷慨 sharing分享 it out
42
101000
3000
他非常大方地跟獄中好友
01:59
with all of his colleagues同事.
43
104000
2000
分享這些海洛因。
02:01
And so everyone大家 lined up,
44
106000
2000
於是每個人排成一排,
02:03
all the smackheadssmackheads in a row,
45
108000
2000
所有的癮君子排成一排。
02:05
and the guy whose誰的 birthday生日 it was
46
110000
2000
而過生日的壽星
02:07
filled填充 up the fit適合,
47
112000
3000
把注射器裝滿海洛因,
02:10
and he went down and started開始 injecting注射 people.
48
115000
2000
然後他走過來開始為大家注射。
02:12
So he injects內噴射 the first guy,
49
117000
2000
他替第一個傢伙注射,
02:14
and then he's wiping the needle on his shirt襯衫,
50
119000
3000
接著他將針頭往襯衫上擦一擦,
02:17
and he injects內噴射 the next下一個 guy.
51
122000
2000
繼續幫下一個傢伙注射。
02:19
And Frankie弗蘭基 says, "I'm number 22 in line,
52
124000
4000
法蘭克說「我排在第22個,
02:23
and I can see the needle coming未來 down towards me,
53
128000
3000
我可以看到朝著我前進的針頭,
02:26
and there is blood血液 all over the place地點.
54
131000
2000
到處都有血跡,
02:28
It's getting得到 blunter直率 and blunter直率.
55
133000
2000
針頭變得越來越鈍,
02:30
And a small part部分 of my brain is thinking思維,
56
135000
3000
然後我大腦的一部分開始思考,
02:33
'That is so gross
57
138000
2000
「這真的很令人作嘔,
02:35
and really dangerous危險,'
58
140000
2000
真的很危險。」
02:37
but most of my brain is thinking思維,
59
142000
2000
但我大部份的腦子想的卻是
02:39
'Please let there be some smack拍擊 left
60
144000
2000
「輪到我的時候
02:41
by the time it gets得到 to me.
61
146000
2000
請留一點點給我。
02:43
Please let there be some left.'"
62
148000
2000
拜託留下一些海洛因給我。」
02:45
And then, telling告訴 me this story故事,
63
150000
2000
接著,故事說完後,
02:47
Frankie弗蘭基 said,
64
152000
2000
法蘭克說,
02:49
"You know ... God,
65
154000
2000
「天啊!你知道嗎?
02:51
drugs毒品 really make you stupid."
66
156000
3000
毒品真的會讓你變得很蠢。」
02:55
And, you know, you can't fault故障 him for accuracy準確性.
67
160000
3000
你也知道,你無法反駁他說的,
02:58
But, actually其實, Frankie弗蘭基, at that time,
68
163000
3000
但事實上,那時的法蘭克
03:01
was a heroin海洛因 addict癮君子 and he was in jail監獄.
69
166000
2000
是個海洛因成癮者,而且他被關在監獄裡。
03:03
So his choice選擇 was either
70
168000
2000
所以他只能選擇
03:05
to accept接受 that dirty needle or not to get high.
71
170000
3000
接受骯髒的針頭或是不要吸毒
03:08
And if there's one place地點 you really want to get high,
72
173000
2000
如果真有個地方會讓你想吸毒,
03:10
it's when you're in jail監獄.
73
175000
2000
那一定是在監獄了
03:12
But I'm a scientist科學家
74
177000
2000
我是個科學家,
03:14
and I don't like to make data數據 out of anecdotes軼事,
75
179000
2000
我不根據八卦軼聞做數據,
03:16
so let's look at some data數據.
76
181000
2000
所以讓我們來看看以下的數據吧。
03:18
We talked to 600 drug藥物 addicts癮君子
77
183000
3000
我們訪談了在印尼三大城市的
03:21
in three cities城市 in Indonesia印度尼西亞,
78
186000
2000
600個毒癮者,
03:23
and we said, "Well, do you know how you get HIVHIV?"
79
188000
2000
我們問:「你知道你是如何感染愛滋的嗎?」
03:25
"Oh yeah, by sharing分享 needles."
80
190000
2000
「噢!那當然! 透過共用的針頭。」
03:27
I mean, nearly幾乎 100 percent百分. Yeah, by sharing分享 needles.
81
192000
3000
幾乎全部的人都知道,是透過共用針頭感染的。
03:30
And, "Do you know where you can get a clean清潔 needle
82
195000
2000
「你知道你可以在哪裡取得乾淨
03:32
at a price價錢 you can afford給予 to avoid避免 that?"
83
197000
2000
而且你也負擔得起的針頭來避免感染愛滋病呢?」
03:34
"Oh yeah." Hundred percent百分.
84
199000
2000
「知道啊!」全部的人都知道。
03:36
"We're smackheadssmackheads; we know where to get clean清潔 needles."
85
201000
2000
「我們是吸毒的人,我們當然知道去哪弄到乾淨的針頭。」
03:38
"So are you carrying攜帶 a needle?"
86
203000
2000
「那你會隨身攜帶針頭嗎?」
03:40
We're actually其實 interviewing面試 people on the street,
87
205000
2000
我們真的就在馬路上採訪這些人,
03:42
in the places地方 where they're hanging out and taking服用 drugs毒品.
88
207000
2000
他們就在這些地方出沒和買賣毒品。
03:44
"Are you carrying攜帶 clean清潔 needles?"
89
209000
2000
「你隨身會帶著乾淨的針頭嗎?」
03:46
One in four, maximum最大值.
90
211000
3000
最多,四個中會有一個帶著。
03:49
So no surprises驚喜 then that
91
214000
2000
這也就難怪
03:51
the proportion比例 that actually其實 used clean清潔 needles
92
216000
2000
上週注射毒品時,
03:53
every一切 time they injected注射 in the last week
93
218000
2000
使用乾淨針頭的
03:55
is just about one in 10,
94
220000
3000
比例只有十分之一,
03:58
and the other nine in 10 are sharing分享.
95
223000
3000
其他的十分之九都是共用針頭。
04:01
So you've got this massive大規模的 mismatch不匹配;
96
226000
2000
你看這是多麼地矛盾,
04:03
everyone大家 knows知道 that
97
228000
2000
大家都知道
04:05
if they share分享 they're going to get HIVHIV,
98
230000
2000
如果他們共用針頭就會感染HIV,
04:07
but they're all sharing分享 anyway無論如何.
99
232000
2000
但他們會共用針頭
04:09
So what's that about? Is it like you get a better high if you share分享 or something?
100
234000
3000
那到底是為什麼呢? 是不是共用東西會讓你比較過癮嗎?
04:12
We asked that to a junkie and they're like, "Are you nuts堅果?"
101
237000
3000
我們問這些吸毒者,他們會說「你瘋了不成?」
04:15
You don't want to share分享 a needle anymore than you want
102
240000
2000
你當然不會想跟別人共用一個針頭
04:17
to share分享 a toothbrush牙刷 even with someone有人 you're sleeping睡眠 with.
103
242000
3000
就像是你也不想跟別人共用牙刷,就算是枕邊人也一樣
04:20
There's just kind of an ickICK factor因子 there.
104
245000
2000
會共用針頭只有一個令人討厭的原因。
04:22
"No, no. We share分享 needles because we don't want to go to jail監獄."
105
247000
3000
不,不。我們共用針頭是因為我們不想進監獄。
04:26
So, in Indonesia印度尼西亞 at this time,
106
251000
3000
所以,現在的印尼,
04:29
if you were carrying攜帶 a needle and the cops警察 rounded you up,
107
254000
3000
如果你隨身帶著針頭,那警察就會把你圍起來,
04:32
they could put you into jail監獄.
108
257000
2000
然後把你丟到牢裡。
04:34
And that changes變化 the equation方程 slightly, doesn't it?
109
259000
2000
這有點改變了整件事,對吧?
04:36
Because your choice選擇 now is either
110
261000
3000
因為當下你的選擇
04:39
I use my own擁有 needle now,
111
264000
4000
我可以用自己的針頭
04:43
or I could share分享 a needle now
112
268000
2000
不然就是共用針頭,
04:45
and get a disease疾病 that's going to
113
270000
2000
然後染上愛滋病,
04:47
possibly或者 kill me 10 years年份 from now,
114
272000
2000
很可能在十年後就因此死掉,
04:49
or I could use my own擁有 needle now
115
274000
3000
或是用我自己的針頭,
04:52
and go to jail監獄 tomorrow明天.
116
277000
3000
然後明天就進監牢。
04:55
And while junkies癮君子 think that
117
280000
2000
雖然毒蟲們覺得
04:57
it's a really bad idea理念 to expose暴露 themselves他們自己 to HIVHIV,
118
282000
3000
把自己暴露在愛滋病病毒下是個極糟的主意,
05:00
they think it's a much worse更差 idea理念
119
285000
2000
但他們深信在牢裡度過一年
05:02
to spend the next下一個 year in jail監獄
120
287000
2000
會是個更糟的決定,
05:04
where they'll他們會 probably大概 end結束 up in Frankie's弗蘭基 situation情況
121
289000
2000
他們很可能在牢裡會面對到法蘭克遇到的狀況,
05:06
and expose暴露 themselves他們自己 to HIVHIV anyway無論如何.
122
291000
3000
然後不管怎樣,還是暴露在HIV的威脅下。
05:09
So, suddenly突然 it becomes perfectly完美 rational合理的
123
294000
2000
突然間,共用針頭似乎
05:11
to share分享 needles.
124
296000
2000
是個相當理性的決定。
05:13
Now, let's look at it from a policy政策 maker's製造商的 point of view視圖.
125
298000
2000
現在,讓我們從決策者的角度來看這個問題。
05:15
This is a really easy簡單 problem問題.
126
300000
2000
這真的是個很簡單的問題。
05:17
For once一旦, your incentives獎勵 are aligned對齊.
127
302000
3000
有那麼一度,你有很足夠的動機做對的決定。
05:20
We've我們已經 got what's rational合理的 for public上市 health健康.
128
305000
3000
我們已經知道就公共衛生而言何謂理性。
05:23
You want people to use clean清潔 needles --
129
308000
2000
政府想要人們使用乾淨的針頭,
05:25
and junkies癮君子 want to use clean清潔 needles.
130
310000
2000
這些毒癮者也想要使用乾淨的針頭。
05:27
So we could make this problem問題 go away
131
312000
2000
所以我們很簡單地就可以解決這個問題,
05:29
simply只是 by making製造 clean清潔 needles universally舉世 available可得到
132
314000
3000
就是讓大家廣泛地拿到乾淨的針頭,
05:32
and taking服用 away the fear恐懼 of arrest逮捕.
133
317000
2000
他們也不用擔心被捕的問題。
05:34
Now, the first person to figure數字 that out
134
319000
2000
第一個想出這一個方法的
05:36
and do something about it on a national國民 scale規模
135
321000
2000
並把它全國性推廣的
05:38
was that well-known知名, bleeding流血的 heart liberal自由主義的
136
323000
3000
就是眾所皆知、心腸善良的民主主義者,
05:41
Margaret瑪格麗特 Thatcher撒切爾.
137
326000
2000
瑪格麗特·柴契爾夫人。
05:43
And she put in the world's世界 first
138
328000
2000
她實施的世界上第一個
05:45
national國民 needle exchange交換 program程序,
139
330000
2000
全國性的針頭交換計畫,
05:47
and other countries國家 followed其次 suit適合: Australia澳大利亞, The Netherlands荷蘭 and few少數 others其他.
140
332000
3000
其他的國家也跟進,包含澳洲、紐西蘭還有一些其他國家,
05:50
And in all of those countries國家, you can see,
141
335000
2000
在這些國家中,你可以看到的,
05:52
not more than four percent百分 of injectors噴油器
142
337000
2000
注射者之中
05:54
ever became成為 infected感染 with HIVHIV.
143
339000
3000
感染上HIV的不超過4%
05:57
Now, places地方 that didn't do this -- New York紐約 City for example,
144
342000
3000
目前,沒有實施這項政策的地方,像是紐約,
06:00
Moscow莫斯科, Jakarta雅加達 --
145
345000
2000
莫斯科,雅加達,
06:02
we're talking, at its peak,
146
347000
2000
我們講的是高峰期,
06:04
one in two injectors噴油器
147
349000
3000
每兩個注射者
06:07
infected感染 with this fatal致命 disease疾病.
148
352000
3000
就有一個會感染上這個致命的疾病。
06:10
Now, Margaret瑪格麗特 Thatcher撒切爾 didn't do this
149
355000
2000
瑪格麗特·柴契爾夫人並不是
06:12
because she has any great love for junkies癮君子.
150
357000
3000
出自於對毒癮者的愛而實施這個政策。
06:15
She did it because she ran a country國家
151
360000
3000
她這麼做是因為她治理著一個
06:18
that had a national國民 health健康 service服務.
152
363000
2000
實施全國性健康福利的國家。
06:20
So, if she didn't invest投資 in effective有效 prevention預防,
153
365000
3000
所以,如果她不先投資來做有效的預防,
06:23
she was going to have pick up the costs成本
154
368000
2000
她就得為後來的治療
06:25
of treatment治療 later後來 on,
155
370000
2000
付出昂貴的代價,
06:27
and obviously明顯 those are much higher更高.
156
372000
2000
很明顯的,後者的代價也高多了。
06:29
So she was making製造 a politically政治上 rational合理的 decision決定.
157
374000
3000
所以她做了一個很理性的政治決定。
06:32
Now, if I take out my
158
377000
2000
現在,如果我戴上了
06:34
public上市 health健康 nerd書呆子 glasses眼鏡 here
159
379000
2000
公共衛生怪胎眼鏡,
06:36
and look at these data數據,
160
381000
3000
再看看這些數據,
06:39
it seems似乎 like a no-brainer沒腦子, doesn't it?
161
384000
3000
這一切看起來很簡單,不是嗎?
06:42
But in this country國家,
162
387000
2000
但在這個國家,
06:44
where the government政府 apparently顯然地 does not feel compelled被迫
163
389000
3000
政府很明顯地覺得並沒有這樣的迫切性
06:47
to provide提供 health健康 care關心 for citizens公民, (Laughter笑聲)
164
392000
2000
去為大眾提供健康醫療,
06:49
we've我們已經 taken採取 a very different不同 approach途徑.
165
394000
3000
於是我們採取了一個很不一樣的解決方法。
06:52
So what we've我們已經 been doing in the United聯合的 States狀態
166
397000
2000
我們在美國一直做的事就是
06:54
is reviewing回顧 the data數據 -- endlessly不休 reviewing回顧 the data數據.
167
399000
3000
驗證這些數據,不停地驗證。
06:57
So, these are reviews評論 of hundreds數以百計 of studies學習
168
402000
3000
你看到的就是數百篇研究的驗證,
07:00
by all the big muckety-mucksmuckety,廢石
169
405000
2000
都是由美國頂尖科學界中的
07:02
of the scientific科學 pantheon萬神殿 in the United聯合的 States狀態,
170
407000
3000
菁英科學家們所整理出來的,
07:05
and these are the studies學習 that show顯示
171
410000
2000
這裡則是一些研究指出
07:07
needle programs程式 are effective有效 -- quite相當 a lot of them.
172
412000
2000
針頭交換計畫是有用的,絕大部分都有。
07:09
Now, the ones那些 that show顯示 that needle programs程式 aren't effective有效 --
173
414000
3000
現在,這些秀出了針頭交換計畫沒有成效的研究,
07:12
you think that's one of these annoying惱人的 dynamic動態 slides幻燈片
174
417000
3000
你們可能會認為這只是一張煩人的幻燈片,
07:15
and I'm going to press my dongle加密狗 and the rest休息 of it's going to come up,
175
420000
2000
而我接著會按下控制,然後其他的幻燈片會接著播放,
07:17
but no -- that's the whole整個 slide滑動.
176
422000
3000
不過並沒有,這就是全部了
07:20
(Laughter笑聲)
177
425000
2000
(笑聲)
07:22
There is nothing on the other side.
178
427000
3000
另外一面沒有東西了
07:27
So, completely全然 irrational不合理的,
179
432000
2000
所以,這是非常不理性的,
07:29
you would think.
180
434000
2000
你會想,
07:31
Except that, wait a minute分鐘, politicians政治家 are rational合理的, too,
181
436000
3000
甚至期待,政客也是有理性的,
07:34
and they're responding響應 to what they think the voters選民 want.
182
439000
3000
而且他們會回應選民所想要的。
07:37
So what we see is that voters選民 respond響應
183
442000
2000
所以我們看到選民會
07:39
very well to things like this
184
444000
2000
很樂於回應像這樣的情況,
07:41
and not quite相當 so well to things like this.
185
446000
3000
而不願意看到這樣的狀況。
07:44
(Laughter笑聲)
186
449000
7000
(為孩童創造美好世界) (為毒蟲創造美好世界)
07:51
So it becomes quite相當 rational合理的
187
456000
3000
所以拒絕提供針頭給成癮者
07:54
to deny拒絕 services服務 to injectors噴油器.
188
459000
3000
變得相當有道理。
07:57
Now let's talk about sex性別.
189
462000
2000
現在讓我們來談談性。
07:59
Are we any more rational合理的 about sex性別?
190
464000
3000
我們面對性會更有理性?
08:02
Well, I'm not even going to address地址
191
467000
2000
我甚至不會去講到
08:04
the clearly明確地 irrational不合理的 positions位置
192
469000
2000
那些天主教教會
08:06
of people like the Catholic天主教徒 Church教會,
193
471000
2000
完全不合邏輯的論點。
08:08
who think somehow不知何故 that if you give out condoms避孕套,
194
473000
3000
他們認為如果你發送保險套,
08:11
everyone's大家的 going to run out and have sex性別.
195
476000
4000
那麼人們就會跑出去性交。
08:15
I don't know if Pope教皇 Benedict本尼迪克特
196
480000
2000
我不知道教皇班尼迪克
08:17
watches手錶 TEDTalksTED演講 online線上,
197
482000
2000
會不會在線上看TEDTalks
08:19
but if you do, I've got news新聞 for you Benedict本尼迪克特 --
198
484000
3000
但如果你有在看,那我有話想跟你說。
08:22
I carry攜帶 condoms避孕套 all the time
199
487000
3000
我隨身都帶著保險套,
08:25
and I never get laid鋪設.
200
490000
2000
我卻從沒有機會使用過。
08:27
(Laughter笑聲) (Applause掌聲)
201
492000
2000
(笑聲)
08:29
It's not that easy簡單!
202
494000
2000
這沒那麼簡單。
08:31
Here, maybe you'll你會 have better luck運氣.
203
496000
2000
也許你運氣會好些。
08:33
(Applause掌聲)
204
498000
6000
(掌聲)
08:39
Okay, seriously認真地,
205
504000
2000
好的,嚴格來說,
08:41
HIVHIV is actually其實 not that easy簡單
206
506000
3000
HIV不是這麼簡單
08:44
to transmit發送 sexually.
207
509000
2000
就透過性交傳染的。
08:46
So, it depends依靠 on how much virus病毒 there is
208
511000
2000
是否會傳染是要看你的血液和體液裡
08:48
in your blood血液 and in your body身體 fluids流體.
209
513000
2000
含著多少愛滋病的病毒。
08:50
And what we've我們已經 got is a very, very high level水平 of virus病毒
210
515000
3000
當感染上的最初期,就在一開始,
08:53
right at the beginning開始 when you're first infected感染,
211
518000
2000
我們身體內會有非常非常高量的病毒數,
08:55
then you start開始 making製造 antibodies抗體,
212
520000
2000
然後你會開始製造抗體,
08:57
and then it bumps顛簸 along沿 at quite相當 low levels水平
213
522000
2000
之後很長的時間內,10年或12年,
08:59
for a long time -- 10 or 12 years年份 --
214
524000
2000
病毒的數量都會維持在相當低的數目,
09:01
you have spikes釘鞋 if you get another另一個 sexually transmitted發送 infection感染.
215
526000
3000
如果你又因性交感染到,那病毒數量會再向上衝。
09:04
But basically基本上, nothing much is going on
216
529000
2000
但基本上來說,身體並不會產生變化
09:06
until直到 you start開始 to get symptomatic症狀 AIDS艾滋病,
217
531000
2000
直到你開始有愛滋病的症狀。
09:08
and by that stage階段,
218
533000
2000
但到了這個階段,就在這,
09:10
you're not looking great, you're not feeling感覺 great,
219
535000
2000
你看起來狀況不會太好,你也會覺得不舒服,
09:12
you're not having that much sex性別.
220
537000
2000
你也不會像以往性交地那樣頻繁。
09:14
So the sexual有性 transmission傳輸 of HIVHIV
221
539000
2000
所以人們是否因性交而感染HIV
09:16
is essentially實質上 determined決心 by how many許多 partners夥伴 you have
222
541000
3000
基本上是取決於這些為期相當短的階段中
09:19
in these very short spaces空間 of time
223
544000
3000
你有多少個性伴侶,
09:22
when you have peak viremia病毒血症.
224
547000
2000
而這時你體內的病毒數量正值高峰期
09:24
Now, this makes品牌 people crazy
225
549000
3000
現在,這就會讓大家抓狂了,
09:27
because it means手段 that you have to talk about
226
552000
3000
因為這意味著你必須討論
09:30
some groups having more sexual有性 partners夥伴
227
555000
2000
有些人會在較短的時間內
09:32
in shorter spaces空間 of time than other groups,
228
557000
2000
比其他人擁有更多性伴侶,
09:34
and that's considered考慮 stigmatizing污名化.
229
559000
2000
而這是很侮辱人的。
09:36
I've always been a bit curious好奇 about that
230
561000
2000
我一直很好奇,
09:38
because I think stigma柱頭 is a bad thing,
231
563000
2000
因為我覺得恥辱是一件不好的事,
09:40
whereas lots of sex性別 is quite相當 a good thing,
232
565000
2000
而頻繁的性交是相當好的一件事,
09:42
but we'll leave離開 that be.
233
567000
3000
不過我們姑且先不討論這個吧。
09:45
The truth真相 is that 20 years年份
234
570000
2000
事實是,耗時20年的
09:47
of very good research研究
235
572000
2000
詳盡研究
09:49
have shown顯示 us that
236
574000
2000
告訴我們
09:51
there are groups that are more likely容易 to turnover周轉
237
576000
3000
有一群人會更傾向於在短時間內
09:54
large numbers數字 of partners夥伴 in a short space空間 of time.
238
579000
2000
換大量的性伴侶,
09:56
And those groups are, globally全球,
239
581000
2000
而這些人,基本上來說
09:58
people who sell sex性別 and their more regular定期 partners夥伴.
240
583000
3000
是賣春者,他們的性伴侶
10:01
They are gay同性戀者 men男人 on the party派對 scene現場
241
586000
2000
多半是舞會上的同性戀者,
10:03
who have, on average平均, three times more partners夥伴
242
588000
2000
而這些人,平均而言都有著比異性戀
10:05
than straight直行 people on the party派對 scene現場.
243
590000
2000
多上三倍的性伴侶,
10:07
And they are heterosexuals異性戀
244
592000
2000
這其中有異性戀,
10:09
who come from countries國家 that have
245
594000
2000
他們的國家有著
10:11
traditions傳統 of polygamy一夫多妻制
246
596000
2000
一妻多夫制的傳統,
10:13
and relatively相對 high levels水平 of female autonomy自治,
247
598000
3000
而女性相對地有較高的女性自主權,
10:16
and almost幾乎 all of those countries國家 are in east or southern南部的 Africa非洲.
248
601000
3000
這些國家大部分都是在南非的東岸。
10:19
And that is reflected反射的 in the epidemic疫情 that we have today今天.
249
604000
3000
這都反映在我們今天面對的傳染病上。
10:22
You can see these horrifying可怕的 figures人物 from Africa非洲.
250
607000
3000
你可以看到這些從非洲得到的可怕數據。
10:25
These are all countries國家 in southern南部的 Africa非洲
251
610000
2000
這些都是在南非的國家,
10:27
where between之間 one in seven,
252
612000
2000
在這裡的成年人
10:29
and one in three
253
614000
2000
3分之一
10:31
of all adults成年人,
254
616000
2000
到7分之一
10:33
are infected感染 with HIVHIV.
255
618000
2000
比例感染HIV
10:35
Now, in the rest休息 of the world世界,
256
620000
2000
現在,在世界上其他的國家,
10:37
we've我們已經 got basically基本上 nothing going on in the general一般 population人口 --
257
622000
3000
基本上人口沒有太大的變化,
10:40
very, very low levels水平 --
258
625000
2000
變動的比例相當相當低,
10:42
but we have extraordinarily異常 high levels水平 of HIVHIV
259
627000
3000
但是在高危險群中
10:45
in these other populations人群 who are at highest最高 risk風險:
260
630000
3000
卻有相當大比例的人感染到HIV
10:48
drug藥物 injectors噴油器, sex性別 workers工人
261
633000
2000
更不用說毒品注射者、性工作者、
10:50
and gay同性戀者 men男人.
262
635000
2000
還有同性戀者。
10:52
And you'll你會 note注意, that's the local本地 data數據 from Los洛杉磯 Angeles洛杉磯:
263
637000
2000
你會看到洛杉磯的數據中,
10:54
25 percent百分 prevalence流行 among其中 gay同性戀者 men男人.
264
639000
3000
同性戀者中有25%的人感染上愛滋。
10:58
Of course課程, you can't get HIVHIV just by having unprotected無保護 sex性別.
265
643000
3000
當然,你不會光是因為不安全的性交而感染HIV
11:01
You can only HIVHIV by having unprotected無保護 sex性別
266
646000
3000
你只會因為跟一個呈陽性反應的HIV患者
11:04
with a positive person.
267
649000
3000
有不安全的性交而染上HIV
11:07
In most of the world世界,
268
652000
2000
在世界上大部分的地方,
11:09
these few少數 prevention預防 failures故障
269
654000
2000
極少數的預防措施失效了,
11:11
notwithstanding雖然,
270
656000
2000
沒有抵抗愛滋成功,
11:13
we are actually其實 doing quite相當 well these days
271
658000
2000
但實際上針對性交易中的預防措施,
11:15
in commercial廣告 sex性別:
272
660000
2000
我們這些日子以來其實做得還不錯。
11:17
condom避孕套 use rates利率 are between之間 80 and 100 percent百分
273
662000
2000
在大部分國家性交易中
11:19
in commercial廣告 sex性別 in most countries國家.
274
664000
3000
保險套的使用率介於80%~100%
11:22
And, again, it's because of an alignment對準 of the incentives獎勵.
275
667000
3000
再一次地說,這都是因為這一連串的鼓勵措施。
11:25
What's rational合理的 for public上市 health健康
276
670000
2000
對公共衛生而言這是理智的,
11:27
is also rational合理的 for individual個人 sex性別 workers工人
277
672000
2000
對個人的性工作者也是理性的選擇。
11:29
because it's really bad for business商業 to have another另一個 STISTI.
278
674000
3000
因為染上性病對生意是很不好的
11:32
No one wants it.
279
677000
2000
沒有人想要這樣。
11:34
And, actually其實, clients客戶 don't want to go home with a drip either.
280
679000
2000
而且,事實上,顧客也不想染病回家。
11:36
So essentially實質上, you're able能夠 to achieve實現
281
681000
3000
所以本質上來說,在性交易這行業中
11:39
quite相當 high rates利率 of condom避孕套 use in commercial廣告 sex性別.
282
684000
3000
是可以達到相當高的保險套使用率。
11:42
But in "intimate親密" relations關係
283
687000
2000
但是在"親密"關係中,
11:44
it's much more difficult because,
284
689000
2000
這就困難多了,
11:46
with your wife妻子 or your boyfriend男朋友
285
691000
2000
因為你的太太或你的男友,
11:48
or someone有人 that you hope希望 might威力 turn into one of those things,
286
693000
3000
或那些你希望成為伴侶的人,
11:51
we have this illusion錯覺 of romance浪漫
287
696000
3000
我們都有著對羅曼史的幻想,
11:54
and trust相信 and intimacy親密關係,
288
699000
2000
信任還有親密度,
11:56
and nothing is quite相當 so unromantic平淡
289
701000
3000
而再也沒有什麼話會比
11:59
as the, "My condom避孕套 or yours你的, darling寵兒?" question.
290
704000
3000
「親愛的,要用誰的保險套呢?」這類的問題更掃興了。
12:02
So in the face面對 of that,
291
707000
3000
所以,面對到這樣的問題,
12:05
you really need quite相當 a strong強大 incentive激勵
292
710000
3000
你真的需要相當大的鼓勵
12:08
to use condoms避孕套.
293
713000
3000
來讓你使用保險套。
12:11
This, for example, this gentleman紳士 is called Joseph約瑟夫.
294
716000
3000
讓我們來舉個例子。這位男士名叫約瑟。
12:14
He's from Haiti海地 and he has AIDS艾滋病.
295
719000
2000
他來自海地,患有愛滋,
12:16
And he's probably大概 not having a lot of sex性別 right now,
296
721000
3000
而他現在大概也沒有活躍的性生活,
12:19
but he is a reminder提醒 in the population人口,
297
724000
2000
但他卻提醒了大眾
12:21
of why you might威力 want to be
298
726000
2000
需要使用保險套
12:23
using運用 condoms避孕套.
299
728000
2000
的原因
12:25
This is also in Haiti海地 and is a reminder提醒
300
730000
2000
這也是在海地,同樣提醒著
12:27
of why you might威力 want to be having sex性別, perhaps也許.
301
732000
3000
大家為何你會想要性交,也許會吧。
12:31
Now, funnily好笑 enough足夠, this is also Joseph約瑟夫
302
736000
3000
現在,還蠻好笑的是,這也是約瑟,
12:34
after six months個月 on antiretroviral抗逆轉錄病毒 treatment治療.
303
739000
3000
是在六個月的抗逆轉錄病毒藥物治療後。
12:38
Not for nothing do we call it the Lazarus拉扎勒斯 Effect影響.
304
743000
3000
這就是我們所說的拉薩路效應。
12:43
But it is changing改變 the equation方程
305
748000
3000
但這改變了等式,
12:46
of what's rational合理的
306
751000
2000
在面對性交時,
12:48
in sexual有性 decision-making做決定.
307
753000
3000
作出怎樣的決定才算理智。
12:51
So, what we've我們已經 got --
308
756000
2000
所以,我們得到這樣的回應。
12:53
some people say, "Oh, it doesn't matter very much
309
758000
2000
有些人會說,「噢,這不太重要,
12:55
because, actually其實, treatment治療 is effective有效 prevention預防
310
760000
3000
因為事實上,治療也是很有效的預防措施,
12:58
because it lowers降低 your viral病毒 load加載 and therefore因此
311
763000
2000
因為治療會降低你體內的病毒量,
13:00
makes品牌 it more difficult to transmit發送 HIVHIV."
312
765000
2000
因此也比較不容易感染到愛滋。」
13:02
So, if you look at the viremia病毒血症 thing again,
313
767000
3000
如果大家再看看這些病毒報告,
13:05
if you do start開始 treatment治療 when you're sick生病,
314
770000
2000
如果在染病時,你真的有接受治療,
13:07
well, what happens發生? Your viral病毒 load加載 comes down.
315
772000
3000
那麼,接著你的病毒攜帶量會下降。
13:10
But compared相比 to what? What happens發生 if you're not on treatment治療?
316
775000
3000
但這是跟什麼數據相比?如果你沒有接受治療呢?
13:14
Well, you die,
317
779000
2000
那,你會死亡,
13:16
so your viral病毒 load加載 goes to zero.
318
781000
2000
所以你的病毒量會降到零。
13:18
And all of this green綠色 stuff東東 here, including包含 the spikes釘鞋 --
319
783000
3000
還有這些綠色部分,包含這些數量衝高的部分,
13:21
which哪一個 are because you couldn't不能 get to the pharmacy藥店,
320
786000
4000
這些都是因為你無法就診,
13:25
or you ran out of drugs毒品, or you went on a three day party派對 binge狂歡
321
790000
3000
或你藥吃完了,或是你去派對狂歡了三天,
13:28
and forgot忘記 to take your drugs毒品,
322
793000
2000
根本就忘了吃藥,
13:30
or because you've started開始 to get resistance抵抗性, or whatever隨你 --
323
795000
3000
又或因為你開始有抗藥性,不管怎樣,
13:33
all of that is virus病毒
324
798000
2000
事實是,愛滋病病毒
13:35
that wouldn't不會 be out there, except for treatment治療.
325
800000
3000
是不會消失不見的,除非你接受治療。
13:38
Now, am I saying, "Oh, well, great prevention預防 strategy戰略.
326
803000
3000
現在,難道我是在說「噢,好吧,這是很棒的預防策略!
13:41
Let's just stop treating治療 people."
327
806000
2000
我們乾脆停止治療吧?」
13:43
Of course課程 not, of course課程 not.
328
808000
2000
當然不是。當然不是這樣。
13:45
We need to expand擴大 antiretroviral抗逆轉錄病毒 treatment治療 as much as we can.
329
810000
3000
我們當然需要盡所可能地擴展這抑制病毒的治療。
13:48
But what I am doing is calling調用 into question
330
813000
2000
但現在我要做的是
13:50
those people who say that more treatment治療
331
815000
2000
問問那些
13:52
is all the prevention預防 we need.
332
817000
2000
說治療勝過預防的人
13:54
That's simply只是 not necessarily一定 true真正,
333
819000
3000
這根本就不是真相,
13:57
and I think we can learn學習 a lot from the experience經驗 of gay同性戀者 men男人
334
822000
2000
我認為我們可以從這些同性戀的經驗中學到更多,
13:59
in rich豐富 countries國家 where treatment治療 has been widely廣泛 available可得到
335
824000
3000
他們身處的國家都有著更普及的治療,
14:02
for going on 15 years年份 now.
336
827000
2000
也已施行15年了,
14:04
And what we've我們已經 seen看到 is
337
829000
2000
我們看到的是,
14:06
that, actually其實, condom避孕套 use rates利率,
338
831000
2000
事實上,保險套的使用率
14:08
which哪一個 were very, very high --
339
833000
2000
相當地高,
14:10
the gay同性戀者 community社區 responded回應 very rapidly急速 to HIVHIV,
340
835000
3000
同性戀群對HIV的反應也很快,
14:13
with extremely非常 little help
341
838000
2000
幾乎不太需要
14:15
from public上市 health健康 nerds書呆子, I would say --
342
840000
2000
來自公共衛生人員的協助,我會說
14:17
that condom避孕套 use rate has come down dramatically顯著 since以來 treatment治療
343
842000
3000
自接受治療後,保險套的使用率明顯驟降,
14:20
for two reasons原因 really:
344
845000
2000
主要是有兩個原因。
14:22
One is the assumption假設 of, "Oh well,
345
847000
2000
其中一個假設是,「噢,
14:24
if he's infected感染, he's probably大概 on meds吃藥,
346
849000
2000
如果他有感染愛滋,他可能在服藥了,
14:26
and his viral病毒 load's負荷的 going to be low, so I'm pretty漂亮 safe安全."
347
851000
3000
那他所攜帶的病毒量一定較低,所以我還蠻安全的。」
14:29
And the other thing is that people are simply只是
348
854000
2000
另一種就是
14:31
not as scared害怕 of HIVHIV
349
856000
2000
人們就根本不怕HIV
14:33
as they were of AIDS艾滋病, and rightly正當地 so.
350
858000
3000
就像他們也不怕愛滋病,的確如此。
14:36
AIDS艾滋病 was a disfiguring毀容 disease疾病 that killed殺害 you,
351
861000
3000
愛滋病是會致死的疾病
14:39
and HIVHIV is an invisible無形 virus病毒
352
864000
2000
而HIV是種看不見的病毒,
14:41
that makes品牌 you take a pill every一切 day.
353
866000
2000
就只是讓你每天吃顆藥。
14:43
And that's boring無聊,
354
868000
2000
這是蠻無趣的,
14:45
but is it as boring無聊 as
355
870000
3000
但這有比
14:48
having to use a condom避孕套 every一切 time you have sex性別,
356
873000
2000
每次性交都使用保險套來得無聊嗎?
14:50
no matter how drunk you are,
357
875000
2000
不管你喝得多醉,
14:52
no matter how many許多 poppers you've taken採取, whatever隨你?
358
877000
3000
不管你喝了多少杯。
14:55
If we look at the data數據, we can see that
359
880000
2000
如果我們看看數據,我們可以發現
14:57
the answer回答 to that question
360
882000
2000
問題的答案就是
14:59
is, mmmMMM.
361
884000
2000
呃....
15:01
So these are data數據 from Scotland蘇格蘭.
362
886000
2000
這些是蘇格蘭的數據。
15:03
You see the peak in drug藥物 injectors噴油器
363
888000
2000
你可以看到毒品注射者染病的高峰期
15:05
before they started開始 the national國民 needle exchange交換 program程序.
364
890000
2000
是在他們開始推行全國性的針頭交換計畫之前。
15:07
Then it came來了 way down.
365
892000
2000
然後數據一路下滑,
15:09
And both in heterosexuals異性戀 -- mostly大多 in commercial廣告 sex性別 --
366
894000
2000
不管是異性戀,其中大多數是性工作者
15:11
and in drug藥物 users用戶,
367
896000
2000
或毒品施打者,
15:13
you've really got nothing much going on after treatment治療 begins開始,
368
898000
3000
在治療開始後,其實不會有太多狀況發生,
15:16
and that's because of that alignment對準 of incentives獎勵
369
901000
2000
這是因為我先前提到的
15:18
that I talked about earlier.
370
903000
2000
一連串的鼓勵措施。
15:20
But in gay同性戀者 men男人,
371
905000
2000
但在同性戀中,
15:22
you've got quite相當 a dramatic戲劇性 rise上升
372
907000
2000
數值急遽上升
15:24
starting開始 three or four years年份
373
909000
2000
就在治療開始變得普及
15:26
after treatment治療 became成為 widely廣泛 available可得到.
374
911000
2000
的三四年間。
15:28
This is of new infections感染.
375
913000
2000
這是新的感染案例。
15:30
What does that mean?
376
915000
2000
這意味著什麼?
15:32
It means手段 that the combined結合 effect影響 of being存在 less worried擔心
377
917000
3000
這意味著人們一方面較不擔心愛滋,
15:35
and having more virus病毒 out there in the population人口 --
378
920000
3000
另一方面在人群中也有著更多的愛滋病毒,
15:38
more people living活的 longer, healthier健康 lives生活,
379
923000
2000
越來越多人活得更久,更健康,
15:40
more likely容易 to be getting得到 laid鋪設
380
925000
2000
也更可能帶著HIV
15:42
with HIVHIV --
381
927000
2000
與別人性交
15:44
is outweighingoutweighing the effects效果 of lower降低 viral病毒 load加載,
382
929000
3000
這兩種影響遠大於較低病毒攜帶量所帶來的影響,
15:47
and that's a very worrisome令人擔憂 thing.
383
932000
2000
而這是件很值得我們擔心的問題。
15:49
What does it mean?
384
934000
2000
這到底指的是什麼?
15:51
It means手段 we need to be doing more prevention預防 the more treatment治療 we have.
385
936000
3000
這說明了當我們有著更好的治療,我們卻也需要做更多的預防措施。
15:54
Is that what's happening事件?
386
939000
2000
實際狀況是這樣嗎?
15:56
No, and I call it the "compassion同情 conundrum難題."
387
941000
3000
不,而且我稱這現象叫同情謎團。
15:59
We've我們已經 talked a lot about compassion同情 the last couple一對 of days,
388
944000
3000
我們過去這幾天談了很多關於同情的話題。
16:02
and what's happening事件 really is that people are
389
947000
3000
而實際的狀況是
16:05
unable無法 quite相當 to bring帶來 themselves他們自己 to put in
390
950000
2000
人們無法真的提供
16:07
good sexual有性 and reproductive生殖 health健康 services服務 for sex性別 workers工人,
391
952000
3000
良好的性交及生育健康服務給性工作者,
16:10
unable無法 quite相當 to be giving out needles to junkies癮君子.
392
955000
3000
也無法發放針頭給毒癮者,
16:13
But once一旦 they've他們已經 gone走了 from being存在
393
958000
3000
但一旦他們不再是
16:16
transgressive海侵 people whose誰的 behaviors行為 we don't want to condone縱容
394
961000
3000
不可饒恕的毒蟲或賣春者
16:19
to being存在 AIDS艾滋病 victims受害者,
395
964000
2000
而是愛滋病受害者時
16:21
we come over all compassionate富於同情心的
396
966000
2000
我們就能有同情心
16:23
and buy購買 them incredibly令人難以置信 expensive昂貴 drugs毒品 for the rest休息 of their lives生活.
397
968000
2000
來為他們一輩子購買這些極為昂貴的藥物,
16:25
It doesn't make any sense
398
970000
2000
從公共衛生的角度看,
16:27
from a public上市 health健康 point of view視圖.
399
972000
2000
這一點都沒道理。
16:29
I want to give what's very nearly幾乎 the last word to Ines伊內斯.
400
974000
4000
我想要跟伊恩絲說些話,這幾乎是最後所說的話了。
16:33
Ines伊內斯 is a a transgender變性 hooker妓女 on the streets街道 of Jakarta雅加達;
401
978000
3000
伊恩絲是個變性人,在雅加達的路上當妓女。
16:36
she's a chick小雞 with a dick迪克.
402
981000
2000
她是個有小雞雞的女生。
16:38
Why does she do that job工作?
403
983000
2000
為什麼她要作妓女呢?
16:40
Well, of course課程, because she's forced被迫 into it
404
985000
3000
當然,這是因為她迫於無奈。
16:43
because she doesn't have any better option選項, etc等等., etc等等.
405
988000
2000
因為她沒有比較好的選擇,等等等。
16:45
And if we could just teach her to sew
406
990000
2000
如果我們可以教她縫紉,
16:47
and get her a nice不錯 job工作 in a factory, all would be well.
407
992000
3000
幫她在工廠找到工作,這一切都會好轉。
16:50
This is what factory workers工人 earn in an hour小時 in Indonesia印度尼西亞:
408
995000
2000
這是印尼的工廠員工一天的所得,
16:52
on average平均, 20 cents.
409
997000
2000
平均20分。
16:54
It varies變化 a bit province to province.
410
999000
2000
會因省份有所不同。
16:56
I do speak說話 to sex性別 workers工人, 15,000 of them
411
1001000
3000
我跟性工作者訪談,在15,000個訪談後,
16:59
for this particular特定 slide滑動,
412
1004000
2000
我得到這張幻燈片。
17:01
and this is what sex性別 workers工人
413
1006000
2000
這是她們說賣春者在
17:03
say they earn in an hour小時.
414
1008000
2000
一個小時中所賺到的。
17:05
So it's not a great job工作, but for a lot of people
415
1010000
3000
所以,這不是件好差事,但對很多人來說,
17:08
it really is quite相當 a rational合理的 choice選擇.
416
1013000
2000
這真的是相當理性的選擇。
17:10
Okay, Ines伊內斯.
417
1015000
2000
好的,伊恩絲。
17:15
We've我們已經 got the tools工具, the knowledge知識 and the cash現金,
418
1020000
5000
我們有工具,知識,也有現金,
17:20
and commitment承諾 to preventing防止 HIVHIV too.
419
1025000
4000
也有著要預防愛滋病病毒的決心。
17:24
Ines伊內斯: So why is prevalence流行 still rising升起?
420
1029000
6000
伊恩絲:那為何愛滋病患者的數目還在上升?
17:30
It's all politics政治.
421
1035000
3000
這都是政治問題。
17:33
When you get to politics政治, nothing makes品牌 sense.
422
1038000
3000
當牽扯到政治,一切都毫無道理了。
17:36
Elizabeth伊麗莎白 Pisani皮薩尼: "When you get to politics政治, nothing makes品牌 sense."
423
1041000
3000
伊麗莎白 ˙皮薩尼:「當牽扯到政治,一切都毫無道理了。」
17:39
So, from the point of view視圖 of a sex性別 worker工人,
424
1044000
3000
所以,從性工作者的角度來看,
17:42
politicians政治家 are making製造 no sense.
425
1047000
2000
政客讓這一切變得很沒有道理。
17:44
From the point of view視圖 of a public上市 health健康 nerd書呆子,
426
1049000
2000
從公共衛生學者的角度看,
17:46
junkies癮君子 are doing dumb things.
427
1051000
3000
毒癮者只是在做蠢事。
17:50
The truth真相 is that everyone大家 has a different不同 rationale合理.
428
1055000
3000
我的意思是,事實是每個人都有不同的合理解釋。
17:53
There are as many許多 different不同 ways方法 of being存在 rational合理的
429
1058000
2000
這個星球有多少人
17:55
as there are human人的 beings眾生 on the planet行星,
430
1060000
2000
就會有同樣多的各種理性決定,
17:57
and that's one of the glories輝煌 of human人的 existence存在.
431
1062000
2000
這也是人類存在的光輝之一。
17:59
But those ways方法 of being存在 rational合理的
432
1064000
2000
但這些不同的理性決定
18:01
are not independent獨立 of one another另一個,
433
1066000
2000
並不是完全和彼此不相干。
18:03
so it's rational合理的 for
434
1068000
2000
對一個毒品注射者來說,
18:05
a drug藥物 injector注射器 to share分享 needles
435
1070000
2000
分享針頭是理智的,
18:07
because of a stupid decision決定 that's made製作 by a politician政治家,
436
1072000
3000
而這全是因為政治家所做出的一個蠢決定。
18:10
and it's rational合理的 for a politician政治家
437
1075000
2000
對一個政治家而言,
18:12
to make that stupid decision決定
438
1077000
3000
做出這個蠢決定也是理智的,
18:15
because they're responding響應 to
439
1080000
2000
因為他們必須對選民的需求
18:17
what they think the voters選民 want.
440
1082000
2000
做出回應。
18:19
But here's這裡的 the thing:
441
1084000
2000
但重點是:
18:21
we are the voters選民.
442
1086000
2000
我們就是選民。
18:23
We're not all of them, of course課程, but TEDTED is a community社區 of opinion意見 leaders領導者.
443
1088000
3000
我們當然不是全部的選民,但是TED是一個有著思想領導者的群體,
18:26
And everyone大家 who's誰是 in this room房間,
444
1091000
2000
在這房間的每一個人,
18:28
and everyone大家 who's誰是 watching觀看 this out there on the web捲筒紙,
445
1093000
3000
還有在線上收看的每一個人,
18:31
I think, has a duty義務 to demand需求 of their politicians政治家
446
1096000
3000
我想我們都有責任要求這些政治家
18:34
that we make policy政策 based基於 on scientific科學 evidence證據
447
1099000
3000
根據科學證據和常識
18:37
and on common共同 sense.
448
1102000
2000
來做出決策。
18:39
It's going to be really hard for us
449
1104000
2000
對我們來說,
18:41
to individually個別地 affect影響 what's rational合理的
450
1106000
3000
單獨影響在世界各地,像法蘭克、伊恩絲
18:44
for every一切 Frankie弗蘭基 and every一切 Ines伊內斯 out there,
451
1109000
2000
這些人,是真的很困難的
18:46
but you can at least最小 use your vote投票
452
1111000
3000
但你可以,至少用你的選票
18:49
to stop politicians政治家 doing stupid things
453
1114000
3000
來阻止政治家做出傳播HIV
18:52
that spread傳播 HIVHIV.
454
1117000
2000
這樣的蠢事
18:54
Thank you.
455
1119000
2000
謝謝!
18:56
(Applause掌聲)
456
1121000
9000
(掌聲)
Translated by Jing Yao
Reviewed by Adrienne Lin

▲Back to top

ABOUT THE SPEAKER
Elizabeth Pisani - Author
In Elizabeth Pisani's latest book, she explores the "improbable nation" of Indonesia.

Why you should listen
In fast-emerging Asia there is one nation that, despite being the world's fourth most-populous (and the third most-populous democracy) and the largest Muslim country (with 210 million people who identify themselves as such), is also, as Elizabeth Pisani writes, "probably the most invisible country in the world". Indonesia. An archipelago of over 17,000 islands that span a distance like that from New York to Alaska, with over 700 languages and a dynamic economy -- but which, puzzingly, doesn't really feature in the global imagination.

Pisani spent two years travelling 23,000 kilometers by boat, bus and motorbike through Indonesia, a place that has fascinated and maddened her since she first lived there over two decades ago. Her portrait of the country, the recent Indonesia Etc.: Exploring the Improbable Nation, reveals the archipelago's complexity and contradictions, a fascinating diversity that "is not just geographic and cultural: different groups are essentially living at different points in human history, all at the same time."

An alumna of various government health agencies, Pisani became an assumption-busting independent researcher and analyst, polling transgendered sex workers, drug addicts and others to illuminate the surprising (and often ignored) demographics that belie traditional studies.

Pisani is fearlessly outspoken on the global failure to understand and manage the realities of AIDS, decrying the tangled roles that money, votes, and media play in the public health landscape. She shows how politics and "morality" have hogtied funding, and advocates for putting dollars where they can actually make a difference. As the Globe and Mail wrote: “Pisani is lucid, colourful, insightful and impatient.”

More profile about the speaker
Elizabeth Pisani | Speaker | TED.com