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

Elizabeth Pisani:性交,毒品,HIV——让我们理智起来

Filmed:
1,494,475 views

滴水不漏的逻辑,智慧,与“公共卫生怪胎”眼镜,Elizabeth Pisani揭开了当今政治体系中,种种妨碍资金有效防止HIV蔓延的不连续性问题。她的对高危人群的研究——从监狱中的瘾君子到柬埔寨街上的性工作者——像我们展示了有时违背意愿的措施却能有效地阻止艾滋的传播。
- 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.
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“人会干傻事。
00:18
That's what spreads利差 HIVHIV."
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于是HIV就传播开来。”
00:20
This was a headline标题 in a U.K. newspaper报纸,
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这句话是一家英国报纸的头条,
00:22
The Guardian监护人, not that long ago.
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不久之前出版的《卫报》。
00:24
I'm curious好奇, show显示 of hands, who agrees同意 with it?
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我很好奇,请大家举个手,谁同意这句话?
00:29
Well, one or two brave勇敢 souls灵魂.
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哦,有一两位勇士。
00:31
This is actually其实 a direct直接 quote引用 from an epidemiologist流行病学家
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这句话实际上出自一位流行病学家之口
00:34
who's谁是 been in field领域 of HIVHIV for 15 years年份,
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她研究HIV已有15年,
00:36
worked工作 on four continents大陆,
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足迹遍布四大洲,
00:38
and you're looking at her.
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你们现在正看着她。
00:40
And I am now going to argue争论
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我现在想说明
00:42
that this is only half true真正.
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这句话只说对了一半。
00:44
People do get HIVHIV because they do stupid things,
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有些人确实是因为做了傻事感染了HIV,
00:47
but most of them are doing stupid things
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但是其中的大多数人虽然做这些傻事
00:49
for perfectly完美 rational合理的 reasons原因.
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却有完全合乎理智的原因。
00:52
Now, "rational合理的" is the dominant优势 paradigm范例
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“理智”是公共卫生的
00:55
in public上市 health健康,
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首要准则。
00:57
and if you put your public上市 health健康 nerd书呆子 glasses眼镜 on,
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现在你戴上公共卫生怪胎眼镜,
01:00
you'll你会 see that if we give people the information信息 that they need
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你便会知道如果你提供给人们必要的信息
01:03
about what's good for them and what's bad for them,
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告诉他们什么对他们好,什么不好,
01:05
if you give them the services服务
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如果你给他们必要的服务
01:07
that they can use to act法案 on that information信息,
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使他们能对上述信息做出反应,
01:09
and a little bit of motivation动机,
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再加上一丁点的鼓励,
01:11
people will make rational合理的 decisions决定
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人们就会做出理智的决定
01:13
and live生活 long and healthy健康 lives生活.
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从此健康长寿。
01:15
Wonderful精彩.
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好极了。
01:17
That's slightly problematic问题 for me because I work in HIVHIV,
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但对于像我这样研究HIV的人,有一点小麻烦,
01:20
and although虽然 I'm sure you all know
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虽然我确信大家都知道
01:22
that HIVHIV is about poverty贫穷 and gender性别 inequality不等式,
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HIV与贫穷和两性不平等有紧密的联系。
01:25
and if you were at TEDTED '07
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如果你参加了TED'07,
01:27
it's about coffee咖啡 prices价格 ...
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就知道HIV与咖啡的价格紧紧相关;
01:29
Actually其实, HIV's艾滋病病毒 about sex性别 and drugs毒品,
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实际上,HIV和性交,毒品脱不了干系。
01:32
and if there are two things that make
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如果说世上有两样东西
01:34
human人的 beings众生 a little bit irrational不合理的,
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使人类丧失理智,
01:36
they are erections勃起 and addiction.
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那就是勃起和上瘾。
01:39
(Laughter笑声)
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(笑声)
01:41
So, let's start开始 with what's rational合理的 for an addict瘾君子.
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那么,我们先说说瘾君子认为什么不和逻辑。
01:44
Now, I remember记得 speaking请讲 to an Indonesian印度尼西亚 friend朋友 of mine, Frankie弗兰基.
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我曾经和一位印尼的朋友,Fankie,聊天。
01:47
We were having lunch午餐 and he was telling告诉 me
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我们一起吃午餐,他跟我讲
01:49
about when he was in jail监狱 in Bali巴厘岛 for a drug药物 injection注射.
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他在巴里岛监狱里注射毒品的经历。
01:52
It was someone's谁家 birthday生日, and they had very kindly和蔼
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那天是一个人的生日,他们偷偷将一些海洛因
01:54
smuggled走私 some heroin海洛因 into jail监狱,
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弄进了监狱,
01:56
and he was very generously慷慨 sharing分享 it out
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他非常大方地邀请牢房里的兄弟们
01:59
with all of his colleagues同事.
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一起享用。
02:01
And so everyone大家 lined up,
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于是每个人都排好队,
02:03
all the smackheadssmackheads in a row,
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所有瘾君子排成一排。
02:05
and the guy whose谁的 birthday生日 it was
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过生日的那个人
02:07
filled填充 up the fit适合,
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准备好注射器,
02:10
and he went down and started开始 injecting注射 people.
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蹲下身,开始给兄弟们注射海洛因。
02:12
So he injects内喷射 the first guy,
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他给第一个兄弟注射后,
02:14
and then he's wiping the needle on his shirt衬衫,
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顺手用衣服擦擦针管,
02:17
and he injects内喷射 the next下一个 guy.
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再注射下一个。
02:19
And Frankie弗兰基 says, "I'm number 22 in line线,
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Frankie说:“我是第22个,
02:23
and I can see the needle coming未来 down towards me,
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我看见针管离我越来越近,
02:26
and there is blood血液 all over the place地点.
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地上到处都是血。
02:28
It's getting得到 blunter直率 and blunter直率.
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针管越来越钝。
02:30
And a small part部分 of my brain is thinking思维,
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我脑子里在想,
02:33
'That is so gross
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“真是恶心死了
02:35
and really dangerous危险,'
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太危险了,”
02:37
but most of my brain is thinking思维,
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但是我更关心的是,
02:39
'Please let there be some smack拍击 left
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拜托,拜托到我的时候
02:41
by the time it gets得到 to me.
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针管里还有点海洛因。
02:43
Please let there be some left.'"
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拜托给我留一点。”
02:45
And then, telling告诉 me this story故事,
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故事讲完后,
02:47
Frankie弗兰基 said,
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Frankie说:
02:49
"You know ... God,
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“你知道,天,
02:51
drugs毒品 really make you stupid."
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毒品真能让你蠢到极点。”
02:55
And, you know, you can't fault故障 him for accuracy准确性.
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而且,你知道,他这句话你挑不出一点毛病,
02:58
But, actually其实, Frankie弗兰基, at that time,
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但是Frankie那时,
03:01
was a heroin海洛因 addict瘾君子 and he was in jail监狱.
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是个瘾君子,而且他被关在监狱。
03:03
So his choice选择 was either
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所以他只能选择
03:05
to accept接受 that dirty needle or not to get high.
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要么接受那血迹斑斑的针头,要么就没法过瘾。
03:08
And if there's one place地点 you really want to get high,
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如果真有什么地方你确实很想过过瘾,
03:10
it's when you're in jail监狱.
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那就是监狱。
03:12
But I'm a scientist科学家
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但现在我是位科学家,
03:14
and I don't like to make data数据 out of anecdotes轶事,
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我不会用八卦故事当数据,
03:16
so let's look at some data数据.
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所以现在来看看数据。
03:18
We talked to 600 drug药物 addicts瘾君子
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我们采访在印尼的三座城市的
03:21
in three cities城市 in Indonesia印度尼西亚,
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600名瘾君子,
03:23
and we said, "Well, do you know how you get HIVHIV?"
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我们问他们:“你知道你怎么感染HIV的吗?”
03:25
"Oh yeah, by sharing分享 needles."
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“哦,当然知道。共用一个针头。”
03:27
I mean, nearly几乎 100 percent百分. Yeah, by sharing分享 needles.
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我是说,差不多100%,对,都是共用针头害的。
03:30
And, "Do you know where you can get a clean清洁 needle
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我们又问:“你知道在哪可以买到
03:32
at a price价钱 you can afford给予 to avoid避免 that?"
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干净又便宜的针头吗?”
03:34
"Oh yeah." Hundred percent百分.
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100%的人都答道:“哦,知道。”
03:36
"We're smackheadssmackheads; we know where to get clean清洁 needles."
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“我们吸毒,我们当然知道上哪儿去弄干净的针头。”
03:38
"So are you carrying携带 a needle?"
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“那你们会带着针头吗?”
03:40
We're actually其实 interviewing面试 people on the street,
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我们采访的那些地方就在街上,
03:42
in the places地方 where they're hanging out and taking服用 drugs毒品.
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瘾君子们聚集在一起服毒。
03:44
"Are you carrying携带 clean清洁 needles?"
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“你们带着干净的针头吗?”
03:46
One in four, maximum最大值.
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最多四分之一的人带着。
03:49
So no surprises惊喜 then that
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所以也难怪
03:51
the proportion比例 that actually其实 used clean清洁 needles
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在上周每次注射时真正
03:53
every一切 time they injected注射 in the last week
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使用干净针头的比例
03:55
is just about one in 10,
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只有十分之一。
03:58
and the other nine in 10 are sharing分享.
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另外十分之九共用一个针头。
04:01
So you've got this massive大规模的 mismatch不匹配;
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你看,这前后矛盾。
04:03
everyone大家 knows知道 that
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每个人都知道
04:05
if they share分享 they're going to get HIVHIV,
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共用针头会感染HIV,
04:07
but they're all sharing分享 anyway无论如何.
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但是他们还是用一个针头。
04:09
So what's that about? Is it like you get a better high if you share分享 or something?
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这是为什么呢?是共用针头让你更过瘾吗?
04:12
We asked that to a junkie and they're like, "Are you nuts坚果?"
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我们这样问他们,他们说:“你疯了?
04:15
You don't want to share分享 a needle anymore than you want
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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,
04:17
to share分享 a toothbrush牙刷 even with someone有人 you're sleeping睡眠 with.
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就算他是你的情人也不行。
04:20
There's just kind of an ickICK factor因子 there.
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这是因为,你知道,ick的原因。
04:22
"No, no. We share分享 needles because we don't want to go to jail监狱."
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不是,不是。我们共用针头因为我们不想进监狱。”
04:26
So, in Indonesia印度尼西亚 at this time,
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现在,在印尼
04:29
if you were carrying携带 a needle and the cops警察 rounded you up,
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如果你被逮到藏有针头,就会被警察抓走,
04:32
they could put you into jail监狱.
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丢进监狱.
04:34
And that changes变化 the equation方程 slightly, doesn't it?
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这样看的话,情况就不一样了,对吗?
04:36
Because your choice选择 now is either
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因为这时你的选择就是,
04:39
I use my own拥有 needle now,
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要么用现在自己的针头,
04:43
or I could share分享 a needle now
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要么现在和别人用一个针头
04:45
and get a disease疾病 that's going to
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感染上病
04:47
possibly或者 kill me 10 years年份 from now,
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过个十年因此而死,
04:49
or I could use my own拥有 needle now
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或者我可以现在用自己的针头
04:52
and go to jail监狱 tomorrow明天.
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明天就去蹲监狱。
04:55
And while junkies瘾君子 think that
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虽然瘾君子们认为
04:57
it's a really bad idea理念 to expose暴露 themselves他们自己 to HIVHIV,
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置身于感染HIV的危险中绝不是什么好事,
05:00
they think it's a much worse更差 idea理念
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但是在监狱里过一年
05:02
to spend the next下一个 year in jail监狱
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更加糟糕,
05:04
where they'll他们会 probably大概 end结束 up in Frankie's弗兰基 situation情况
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你很可能在监狱里遇上Frankie所说的情况
05:06
and expose暴露 themselves他们自己 to HIVHIV anyway无论如何.
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最终还是可能感染HIV。
05:09
So, suddenly突然 it becomes perfectly完美 rational合理的
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这样,突然间,共用针头
05:11
to share分享 needles.
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就变得非常有道理了。
05:13
Now, let's look at it from a policy政策 maker's制造商的 point of view视图.
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现在我们从政策决策者的角度看看这个问题。
05:15
This is a really easy简单 problem问题.
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实际上非常简单。
05:17
For once一旦, your incentives奖励 are aligned对齐.
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终于有一次,大家达成了一致意见。
05:20
We've我们已经 got what's rational合理的 for public上市 health健康.
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从公共卫生角度,我们得出了理性的答案。
05:23
You want people to use clean清洁 needles --
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我们希望瘾君子用干净的针头,
05:25
and junkies瘾君子 want to use clean清洁 needles.
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瘾君子也想用干净的针头。
05:27
So we could make this problem问题 go away
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所以我们只用使瘾君子们能随时拿到针头
05:29
simply只是 by making制造 clean清洁 needles universally举世 available可得到
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同时让他们不必担心被逮捕
05:32
and taking服用 away the fear恐惧 of arrest逮捕.
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就能解决这个问题。
05:34
Now, the first person to figure数字 that out
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而第一个想出这一招
05:36
and do something about it on a national国民 scale规模
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并在全国执行的人
05:38
was that well-known知名, bleeding流血的 heart liberal自由主义的
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就是大名鼎鼎的“铁娘子”
05:41
Margaret玛格丽特 Thatcher撒切尔.
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英国首相撒切尔夫人。
05:43
And she put in the world's世界 first
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她推行了全球第一项
05:45
national国民 needle exchange交换 program程序,
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国家针头交换计划
05:47
and other countries国家 followed其次 suit适合: Australia澳大利亚, The Netherlands荷兰 and few少数 others其他.
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其他国家竞相效仿,澳大利亚,荷兰和一小部分其他国家,
05:50
And in all of those countries国家, you can see,
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在这些国家里,你们可以看到,
05:52
not more than four percent百分 of injectors喷油器
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低于百分之四的吸毒人员
05:54
ever became成为 infected感染 with HIVHIV.
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曾因注射而感染HIV。
05:57
Now, places地方 that didn't do this -- New York纽约 City for example,
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再看,没有实行这一政策的国家,比如纽约,
06:00
Moscow莫斯科, Jakarta雅加达 --
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莫斯科,雅加达,
06:02
we're talking, at its peak,
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在峰值时,
06:04
one in two injectors喷油器
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每两个注射毒品的人中
06:07
infected感染 with this fatal致命 disease疾病.
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就有一个感染了这种致命疾病。
06:10
Now, Margaret玛格丽特 Thatcher撒切尔 didn't do this
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撒切尔首相做这些
06:12
because she has any great love for junkies瘾君子.
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不是因为她对瘾君子有恻隐之心,
06:15
She did it because she ran a country国家
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她这样做是她执政的国家
06:18
that had a national国民 health健康 service服务.
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有国家免费医疗系统。
06:20
So, if she didn't invest投资 in effective有效 prevention预防,
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所以,如果她不在有效疾病预防方面投资,
06:23
she was going to have pick up the costs成本
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她以后就必须为疾病的治疗
06:25
of treatment治疗 later后来 on,
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付出昂贵的费用,
06:27
and obviously明显 those are much higher更高.
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而且治疗的费用昂贵的多。
06:29
So she was making制造 a politically政治上 rational合理的 decision决定.
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所以她做出了一个政治上很理智的决定。
06:32
Now, if I take out my
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现在,如果我带上我
06:34
public上市 health健康 nerd书呆子 glasses眼镜 here
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公共卫生怪胎的眼镜,
06:36
and look at these data数据,
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再看看这些数据,
06:39
it seems似乎 like a no-brainer没脑子, doesn't it?
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这完全不合逻辑。
06:42
But in this country国家,
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但是在这个国家,
06:44
where the government政府 apparently显然地 does not feel compelled被迫
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政府显然不认为他们必须
06:47
to provide提供 health健康 care关心 for citizens公民, (Laughter笑声)
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为公民提供免费医疗,
06:49
we've我们已经 taken采取 a very different不同 approach途径.
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我们于是采取了大相径庭的解决方法。
06:52
So what we've我们已经 been doing in the United联合的 States状态
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在美国,我们一直在做的事情是
06:54
is reviewing回顾 the data数据 -- endlessly不休 reviewing回顾 the data数据.
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验证数据,不断地验证。
06:57
So, these are reviews评论 of hundreds数以百计 of studies学习
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于是上百个研究的数据
07:00
by all the big muckety-mucksmuckety,废石
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被大型的muckety-mucks
07:02
of the scientific科学 pantheon万神殿 in the United联合的 States状态,
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美国科学界圣人验证,
07:05
and these are the studies学习 that show显示
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而大量的研究表明
07:07
needle programs程式 are effective有效 -- quite相当 a lot of them.
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针头计划是有效的。
07:09
Now, the ones那些 that show显示 that needle programs程式 aren't effective有效 --
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再看,这些表明针头计划无效的研究
07:12
you think that's one of these annoying恼人的 dynamic动态 slides幻灯片
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你们认为在这张烦人的幻灯片上,
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,
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我按一下手中的遥控器,剩下的数据就会出现,
07:17
but no -- that's the whole整个 slide滑动.
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但是,没有,这张幻灯片上就这么多内容。
07:20
(Laughter笑声)
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(笑声)
07:22
There is nothing on the other side.
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另外一栏什么也没有。
07:27
So, completely全然 irrational不合理的,
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那么,这完完全全没有道理。
07:29
you would think.
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你肯定这样想,
07:31
Except that, wait a minute分钟, politicians政治家 are rational合理的, too,
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只是,等下,不对,政客们也是理智的,
07:34
and they're responding响应 to what they think the voters选民 want.
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而且他们所做的事情是他们认为选民们想做的。
07:37
So what we see is that voters选民 respond响应
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我们看到的是选民们都
07:39
very well to things like this
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十分愿意回应这种情况
07:41
and not quite相当 so well to things like this.
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而不愿意回应这种情况。
07:44
(Laughter笑声)
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(笑声)
07:51
So it becomes quite相当 rational合理的
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所以拒绝向瘾君子提供服务
07:54
to deny拒绝 services服务 to injectors喷油器.
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就显得很有道理。
07:57
Now let's talk about sex性别.
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现在来说说性交。
07:59
Are we any more rational合理的 about sex性别?
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我们在性交上更理智吗?
08:02
Well, I'm not even going to address地址
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呃,我根本不会去评论
08:04
the clearly明确地 irrational不合理的 positions位置
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天主教徒们那些
08:06
of people like the Catholic天主教徒 Church教会,
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完全不和逻辑的想法。
08:08
who think somehow不知何故 that if you give out condoms避孕套,
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以为只要你免费发保险套,
08:11
everyone's大家的 going to run out and have sex性别.
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人们就会出去找乐子。
08:15
I don't know if Pope教皇 Benedict本尼迪克特
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我不知道本尼迪克特教皇
08:17
watches手表 TEDTalksTED演讲 online线上,
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是否会在线看TED的演讲,
08:19
but if you do, I've got news新闻 for you Benedict本尼迪克特 --
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但是教皇,您看的话,我有话要跟您讲。
08:22
I carry携带 condoms避孕套 all the time
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我随身带着保险套,
08:25
and I never get laid铺设.
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但从来没机会用。
08:27
(Laughter笑声) (Applause掌声)
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(笑声)
08:29
It's not that easy简单!
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这种机会可不容易找。
08:31
Here, maybe you'll你会 have better luck运气.
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接着,也许你的运气好一点。
08:33
(Applause掌声)
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(掌声)
08:39
Okay, seriously认真地,
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OK,严格地说,
08:41
HIVHIV is actually其实 not that easy简单
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HIV不是很容易
08:44
to transmit发送 sexually.
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通过性交传染。
08:46
So, it depends依靠 on how much virus病毒 there is
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是否传染取决于你血液和体液所含的
08:48
in your blood血液 and in your body身体 fluids流体.
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病毒数量
08:50
And what we've我们已经 got is a very, very high level水平 of virus病毒
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当某人感染HIV后,在感染最初期
08:53
right at the beginning开始 when you're first infected感染,
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病毒含量非常,非常高,
08:55
then you start开始 making制造 antibodies抗体,
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然后你的身体开始产生抗体,
08:57
and then it bumps颠簸 along沿 at quite相当 low levels水平
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之后很长的一段时间内
08:59
for a long time -- 10 or 12 years年份 --
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10年或12年,病毒的含量都保持在相当低的水平,
09:01
you have spikes钉鞋 if you get another另一个 sexually transmitted发送 infection感染.
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如果你有与他人发生关系而受到感染,you have spikes ,
09:04
But basically基本上, nothing much is going on
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但一般而言,在你开始出现艾滋病的
09:06
until直到 you start开始 to get symptomatic症状 AIDS艾滋病,
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症状之前,不会发生什么。
09:08
and by that stage阶段,
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而到了那一阶段,这里,
09:10
you're not looking great, you're not feeling感觉 great,
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你会看起来很糟,感觉很不好,
09:12
you're not having that much sex性别.
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不会发生很多性交。
09:14
So the sexual有性 transmission传输 of HIVHIV
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所以通过性交感染HIV基本取决于
09:16
is essentially实质上 determined决心 by how many许多 partners伙伴 you have
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当你体内的病毒达到高潮时
09:19
in these very short spaces空间 of time
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的那一段非常短的时间段内
09:22
when you have peak viremia病毒血症.
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你有多少位同伴。
09:24
Now, this makes品牌 people crazy
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这一来人们就要发疯了
09:27
because it means手段 that you have to talk about
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因为这意味着你必须谈论
09:30
some groups having more sexual有性 partners伙伴
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有些人在较短的时间内
09:32
in shorter spaces空间 of time than other groups,
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比另外一些人有更多的同伴,
09:34
and that's considered考虑 stigmatizing污名化.
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这样就太侮辱人了。
09:36
I've always been a bit curious好奇 about that
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我一直都对此很好奇
09:38
because I think stigma柱头 is a bad thing,
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因为我认为侮辱是件很不好的事情,
09:40
whereas lots of sex性别 is quite相当 a good thing,
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而然性交频繁却是件很好的事,
09:42
but we'll leave离开 that be.
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不过这事就这样吧。
09:45
The truth真相 is that 20 years年份
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事实是20年来
09:47
of very good research研究
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很出色的研究
09:49
have shown显示 us that
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告诉我们
09:51
there are groups that are more likely容易 to turnover周转
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有一些人更倾向于
09:54
large numbers数字 of partners伙伴 in a short space空间 of time.
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在短时期内有很多伙伴,
09:56
And those groups are, globally全球,
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而基本上这些人,
09:58
people who sell sex性别 and their more regular定期 partners伙伴.
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都是出卖色情,有更多的同伴,
10:01
They are gay同性恋者 men男人 on the party派对 scene现场
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在派对上的同性恋拥有的伙伴数量
10:03
who have, on average平均, three times more partners伙伴
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平均比派对上的异性恋
10:05
than straight直行 people on the party派对 scene现场.
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多出两倍,
10:07
And they are heterosexuals异性恋
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还有些异性恋
10:09
who come from countries国家 that have
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他们来自的国家
10:11
traditions传统 of polygamy一夫多妻制
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有一妻多夫的传统
10:13
and relatively相对 high levels水平 of female autonomy自治,
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女性有较强的自主权,
10:16
and almost几乎 all of those countries国家 are in east or southern南部的 Africa非洲.
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大多数此类国家都在南部非洲的东部。
10:19
And that is reflected反射的 in the epidemic疫情 that we have today今天.
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这些都反映在现在大范围流行的疾病上。
10:22
You can see these horrifying可怕的 figures人物 from Africa非洲.
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大家看来自非洲的这些数据,让人不寒而栗。
10:25
These are all countries国家 in southern南部的 Africa非洲
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这些全部是南部非洲的国家
10:27
where between之间 one in seven,
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七分之一
10:29
and one in three
253
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到三分之一
10:31
of all adults成年人,
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的成年人
10:33
are infected感染 with HIVHIV.
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都感染了HIV。
10:35
Now, in the rest休息 of the world世界,
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而在世界其他国家,
10:37
we've我们已经 got basically基本上 nothing going on in the general一般 population人口 --
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基本上普通大众平安无事,
10:40
very, very low levels水平 --
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非常低的比率,
10:42
but we have extraordinarily异常 high levels水平 of HIVHIV
259
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但是HIV携带率
10:45
in these other populations人群 who are at highest最高 risk风险:
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在高危人群中的比率异常的高,
10:48
drug药物 injectors喷油器, sex性别 workers工人
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像注射毒品的瘾君子,性工作者,
10:50
and gay同性恋者 men男人.
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男同性恋。
10:52
And you'll你会 note注意, that's the local本地 data数据 from Los洛杉矶 Angeles洛杉矶:
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大家注意看旧金山的地方数据。
10:54
25 percent百分 prevalence流行 among其中 gay同性恋者 men男人.
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有25%的同性恋感染了HIV。
10:58
Of course课程, you can't get HIVHIV just by having unprotected无保护 sex性别.
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当然,如果只进行无预防措施的性交不会染上HIV。
11:01
You can only HIVHIV by having unprotected无保护 sex性别
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你只有和在传染期的携带者
11:04
with a positive person.
267
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发生无预防措施的性交才会染病。
11:07
In most of the world世界,
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在世界大多数地方,
11:09
these few少数 prevention预防 failures故障
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有些预防措施失效了
11:11
notwithstanding虽然,
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但不多,
11:13
we are actually其实 doing quite相当 well these days
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在性交易行业里
11:15
in commercial广告 sex性别:
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实际上,我们(预防措施)做的很不错。
11:17
condom避孕套 use rates利率 are between之间 80 and 100 percent百分
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在大多数国家性性交易行业
11:19
in commercial广告 sex性别 in most countries国家.
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安全套的使用率在80%到100%。
11:22
And, again, it's because of an alignment对准 of the incentives奖励.
275
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正是因为形成了这些鼓励措施
11:25
What's rational合理的 for public上市 health健康
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对公共卫生讲这是理智的行为
11:27
is also rational合理的 for individual个人 sex性别 workers工人
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对个体性工作者也是理智的。
11:29
because it's really bad for business商业 to have another另一个 STISTI.
278
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因为染上病会影响生意。
11:32
No one wants it.
279
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没人希望如此。
11:34
And, actually其实, clients客户 don't want to go home with a drip either.
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而且,也没有哪个顾客想带病回家。
11:36
So essentially实质上, you're able能够 to achieve实现
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所以最终,你可以在性交易行业
11:39
quite相当 high rates利率 of condom避孕套 use in commercial广告 sex性别.
282
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达到高安全套使用率。
11:42
But in "intimate亲密" relations关系
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但是在“亲密”关系中,
11:44
it's much more difficult because,
284
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就困难的多了
11:46
with your wife妻子 or your boyfriend男朋友
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因为也许你的妻子或男友,
11:48
or someone有人 that you hope希望 might威力 turn into one of those things,
286
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或你想进一步发展成为恋人或配偶的那个人,
11:51
we have this illusion错觉 of romance浪漫
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因为某种浪漫的幻想
11:54
and trust相信 and intimacy亲密关系,
288
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信任和亲密,
11:56
and nothing is quite相当 so unromantic平淡
289
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3000
没有什么比“亲爱的,用你的安全套还是我的”
11:59
as the, "My condom避孕套 or yours你的, darling宠儿?" question.
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这样的问题,更让人扫兴的了。
12:02
So in the face面对 of that,
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所以,在那种情况下,
12:05
you really need quite相当 a strong强大 incentive激励
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你需要有强大的意愿
12:08
to use condoms避孕套.
293
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才会使用安全套。
12:11
This, for example, this gentleman绅士 is called Joseph约瑟夫.
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就像这位先生,他叫Joseph。
12:14
He's from Haiti海地 and he has AIDS艾滋病.
295
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来自海地,患有艾滋,
12:16
And he's probably大概 not having a lot of sex性别 right now,
296
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3000
现在他大概没有什么性交,
12:19
but he is a reminder提醒 in the population人口,
297
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但是他提醒着其他的人们,
12:21
of why you might威力 want to be
298
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你为什么想用
12:23
using运用 condoms避孕套.
299
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2000
安全套。
12:25
This is also in Haiti海地 and is a reminder提醒
300
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2000
这张也在海地,提醒着你
12:27
of why you might威力 want to be having sex性别, perhaps也许.
301
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为什么想上床。
12:31
Now, funnily好笑 enough足够, this is also Joseph约瑟夫
302
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3000
好了,挺好笑,这张还是Joseph。
12:34
after six months个月 on antiretroviral抗逆转录病毒 treatment治疗.
303
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3000
在进行抗病毒治疗6个月后(的照片)。
12:38
Not for nothing do we call it the Lazarus拉扎勒斯 Effect影响.
304
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这就是为什么我们称之为拉撒路效应。
12:43
But it is changing改变 the equation方程
305
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3000
但是这样一来等式两边就不平衡了
12:46
of what's rational合理的
306
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在性交时
12:48
in sexual有性 decision-making做决定.
307
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什么样的决定才是理智的。
12:51
So, what we've我们已经 got --
308
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我们听到
12:53
some people say, "Oh, it doesn't matter very much
309
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有些人说:“这没什么要紧的
12:55
because, actually其实, treatment治疗 is effective有效 prevention预防
310
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因为实际上,治疗非常有效
12:58
because it lowers降低 your viral病毒 load加载 and therefore因此
311
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2000
治疗使你体内的病毒减少了
13:00
makes品牌 it more difficult to transmit发送 HIVHIV."
312
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2000
所以就很难传递HIV了。”
13:02
So, if you look at the viremia病毒血症 thing again,
313
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那么,如果大家再看看感染病毒的情况,
13:05
if you do start开始 treatment治疗 when you're sick生病,
314
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如果你在生病时就开始治疗,
13:07
well, what happens发生? Your viral病毒 load加载 comes down.
315
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你体内的病毒携带量就会下降。
13:10
But compared相比 to what? What happens发生 if you're not on treatment治疗?
316
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但是这跟怎么比呢?如果你没有接受治疗呢?
13:14
Well, you die,
317
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2000
那你就会死,
13:16
so your viral病毒 load加载 goes to zero.
318
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这样你体内的病毒携带量变成了零。
13:18
And all of this green绿色 stuff东东 here, including包含 the spikes钉鞋 --
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这些绿色部分,包括SPIKES,
13:21
which哪一个 are because you couldn't不能 get to the pharmacy药店,
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是因为你没有去看医生
13:25
or you ran out of drugs毒品, or you went on a three day party派对 binge狂欢
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或者你没有药了,或者你去派对狂欢三天
13:28
and forgot忘记 to take your drugs毒品,
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完全忘记吃药,
13:30
or because you've started开始 to get resistance抵抗性, or whatever随你 --
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或者你的身体开始产生抗药性,或者随便别的什么,
13:33
all of that is virus病毒
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这些全部是病毒
13:35
that wouldn't不会 be out there, except for treatment治疗.
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不是因为治疗,这些都不会在这里。
13:38
Now, am I saying, "Oh, well, great prevention预防 strategy战略.
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那我的意思是,好啊,多棒的预防策略啊,
13:41
Let's just stop treating治疗 people."
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我们都别给患者治病了吧?
13:43
Of course课程 not, of course课程 not.
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当然不是,当然不是,
13:45
We need to expand扩大 antiretroviral抗逆转录病毒 treatment治疗 as much as we can.
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我们必须尽量让更多的人接受抗病毒的治疗。
13:48
But what I am doing is calling调用 into question
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但是我要提出一个问题
13:50
those people who say that more treatment治疗
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问那些说只要更多的治疗就足够我们预防艾滋的人
13:52
is all the prevention预防 we need.
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你们凭什么这么说。
13:54
That's simply只是 not necessarily一定 true真正,
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事实显然并非如此,
13:57
and I think we can learn学习 a lot from the experience经验 of gay同性恋者 men男人
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在发达国家艾滋病的治疗已经普及了15年,
13:59
in rich丰富 countries国家 where treatment治疗 has been widely广泛 available可得到
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我们可以在那些国家的男同性恋那里
14:02
for going on 15 years年份 now.
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学到很多教训,
14:04
And what we've我们已经 seen看到 is
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我们看到
14:06
that, actually其实, condom避孕套 use rates利率,
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实际上,安全套的使用率
14:08
which哪一个 were very, very high --
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非常,非常高
14:10
the gay同性恋者 community社区 responded回应 very rapidly急速 to HIVHIV,
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同性恋群中,对HIV的反应也很迅速,
14:13
with extremely非常 little help
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几乎不需要
14:15
from public上市 health健康 nerds书呆子, I would say --
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公共卫生人员的帮助
14:17
that condom避孕套 use rate has come down dramatically显着 since以来 treatment治疗
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接受治疗后,安全套的使用率开始锐减
14:20
for two reasons原因 really:
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主要有两个原因。
14:22
One is the assumption假设 of, "Oh well,
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有一种想法是:“呃,
14:24
if he's infected感染, he's probably大概 on meds吃药,
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要是他感染了,他肯定在吃药,
14:26
and his viral病毒 load's负荷的 going to be low, so I'm pretty漂亮 safe安全."
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那他的病毒携带量就很低,所以我安全的很。”
14:29
And the other thing is that people are simply只是
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另一个原因是人们根本
14:31
not as scared害怕 of HIVHIV
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不像害怕艾滋一样
14:33
as they were of AIDS艾滋病, and rightly正当地 so.
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害怕HIV,这样想也对。
14:36
AIDS艾滋病 was a disfiguring毁容 disease疾病 that killed杀害 you,
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艾滋把你折腾的不像人样,还致你于死命,
14:39
and HIVHIV is an invisible无形 virus病毒
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HIV是看不见摸不着的病毒
14:41
that makes品牌 you take a pill every一切 day.
353
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害你每天吃片药。
14:43
And that's boring无聊,
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真无聊,
14:45
but is it as boring无聊 as
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就和每次做爱都要用安全套
14:48
having to use a condom避孕套 every一切 time you have sex性别,
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一样的无聊,
14:50
no matter how drunk you are,
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不管你喝的多醉,
14:52
no matter how many许多 poppers you've taken采取, whatever随你?
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不管你和几个瘾君子上床,什么都不管
14:55
If we look at the data数据, we can see that
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看看数据,我们会发现
14:57
the answer回答 to that question
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问题的答案就在
14:59
is, mmmMMM.
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嗯——
15:01
So these are data数据 from Scotland苏格兰.
362
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这些是苏格兰的数据
15:03
You see the peak in drug药物 injectors喷油器
363
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你看毒品注射者这些峰值
15:05
before they started开始 the national国民 needle exchange交换 program程序.
364
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是在苏格兰全国针头交换计划实施之前
15:07
Then it came来了 way down.
365
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之后人数下降了
15:09
And both in heterosexuals异性恋 -- mostly大多 in commercial广告 sex性别 --
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不管是异性恋,大多数是性工作者
15:11
and in drug药物 users用户,
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还是瘾君子,
15:13
you've really got nothing much going on after treatment治疗 begins开始,
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在开始治疗之后,基本上没有出现任何状况,
15:16
and that's because of that alignment对准 of incentives奖励
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这要归功于我先前提到的
15:18
that I talked about earlier.
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那些鼓励政策
15:20
But in gay同性恋者 men男人,
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但是男同性恋中,
15:22
you've got quite相当 a dramatic戏剧性 rise上升
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在治疗广泛推行的
15:24
starting开始 three or four years年份
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三四年内
15:26
after treatment治疗 became成为 widely广泛 available可得到.
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数量却急剧上升。
15:28
This is of new infections感染.
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这些是新增的感染者。
15:30
What does that mean?
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这意味着什么?
15:32
It means手段 that the combined结合 effect影响 of being存在 less worried担心
377
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这意味着一方面人们不再那么害怕(HIV)
15:35
and having more virus病毒 out there in the population人口 --
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而另一方面,病毒携带者的数量增加了,
15:38
more people living活的 longer, healthier健康 lives生活,
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2000
更多人活的更长,更健康,
15:40
more likely容易 to be getting得到 laid铺设
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更可能身为HIV携带者依然进行性交
15:42
with HIVHIV --
381
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这些综合因素的影响
15:44
is outweighingoutweighing the effects效果 of lower降低 viral病毒 load加载,
382
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3000
已超过了低病毒携带的影响,
15:47
and that's a very worrisome令人担忧 thing.
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这让我很担心。
15:49
What does it mean?
384
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这意味着什么?
15:51
It means手段 we need to be doing more prevention预防 the more treatment治疗 we have.
385
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这意味着医疗方法越进步,我们越要加强预防力度。
15:54
Is that what's happening事件?
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2000
实际情况时这样的吗?
15:56
No, and I call it the "compassion同情 conundrum难题."
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不,我把这种情况称作同情难题。
15:59
We've我们已经 talked a lot about compassion同情 the last couple一对 of days,
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3000
这两天我们常常讨论同情心。
16:02
and what's happening事件 really is that people are
389
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现在的情况是人们
16:05
unable无法 quite相当 to bring带来 themselves他们自己 to put in
390
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2000
很难做到
16:07
good sexual有性 and reproductive生殖 health健康 services服务 for sex性别 workers工人,
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3000
为性工作者提供高质量的性和生育健康服务,
16:10
unable无法 quite相当 to be giving out needles to junkies瘾君子.
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3000
很难给瘾君子发针头,
16:13
But once一旦 they've他们已经 gone走了 from being存在
393
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但是一旦他们不再是不可饶恕的
16:16
transgressive海侵 people whose谁的 behaviors行为 we don't want to condone纵容
394
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3000
瘾君子或性工作者,
16:19
to being存在 AIDS艾滋病 victims受害者,
395
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2000
而成为了艾滋病人,
16:21
we come over all compassionate富于同情心的
396
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我们会抛开一切情绪
16:23
and buy购买 them incredibly令人难以置信 expensive昂贵 drugs毒品 for the rest休息 of their lives生活.
397
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2000
为他们买昂贵的药物,直到他们生命终结的那天。
16:25
It doesn't make any sense
398
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2000
从公共卫生的角度讲
16:27
from a public上市 health健康 point of view视图.
399
972000
2000
这完全没有道理。
16:29
I want to give what's very nearly几乎 the last word to Ines伊内斯.
400
974000
4000
我想对Ines说几句离别的话。
16:33
Ines伊内斯 is a a transgender变性 hooker妓女 on the streets街道 of Jakarta雅加达;
401
978000
3000
Ines是为变性人,她在雅加达的街上当妓女。
16:36
she's a chick小鸡 with a dick迪克.
402
981000
2000
她是有小鸡鸡的女生。
16:38
Why does she do that job工作?
403
983000
2000
她为什么当妓女?
16:40
Well, of course课程, because she's forced被迫 into it
404
985000
3000
当然是因为她被逼无奈
16:43
because she doesn't have any better option选项, etc等等., etc等等.
405
988000
2000
别无选择,等等等等,
16:45
And if we could just teach her to sew
406
990000
2000
但是如果我们教她缝纫
16:47
and get her a nice不错 job工作 in a factory, all would be well.
407
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3000
给她在工厂里提供一份好工作,事情就圆满了。
16:50
This is what factory workers工人 earn in an hour小时 in Indonesia印度尼西亚:
408
995000
2000
在印尼,工厂工人平均一个小时
16:52
on average平均, 20 cents.
409
997000
2000
赚20美分。
16:54
It varies变化 a bit province to province.
410
999000
2000
每个省份的情况稍微有点不同。
16:56
I do speak说话 to sex性别 workers工人, 15,000 of them
411
1001000
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这张幻灯片上的数据
16:59
for this particular特定 slide滑动,
412
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2000
来自我在和15000名性工作者的谈话。
17:01
and this is what sex性别 workers工人
413
1006000
2000
这是性工作者自报的
17:03
say they earn in an hour小时.
414
1008000
2000
每小时的薪水。
17:05
So it's not a great job工作, but for a lot of people
415
1010000
3000
这个工作不怎么样,但是对很对人而言
17:08
it really is quite相当 a rational合理的 choice选择.
416
1013000
2000
确实很明智的选择。
17:10
Okay, Ines伊内斯.
417
1015000
2000
OK,Ines。
17:15
We've我们已经 got the tools工具, the knowledge知识 and the cash现金,
418
1020000
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我们也有方法,知识,现金,
17:20
and commitment承诺 to preventing防止 HIVHIV too.
419
1025000
4000
以及决心,防治HIV。
17:24
Ines伊内斯: So why is prevalence流行 still rising升起?
420
1029000
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Ines:那为什么HIV的携带者数量还在上升?
17:30
It's all politics政治.
421
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3000
都是因为政治原因。
17:33
When you get to politics政治, nothing makes品牌 sense.
422
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当政治介入后,一切都变得毫无道理。
17:36
Elizabeth伊丽莎白 Pisani皮萨尼: "When you get to politics政治, nothing makes品牌 sense."
423
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Elizabeth Pisani:“当政治介入后,一切都变得毫无道理。”
17:39
So, from the point of view视图 of a sex性别 worker工人,
424
1044000
3000
从性工作者的角度看,
17:42
politicians政治家 are making制造 no sense.
425
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政客们完全没有道理。
17:44
From the point of view视图 of a public上市 health健康 nerd书呆子,
426
1049000
2000
从公共卫生怪胎的角度看,
17:46
junkies瘾君子 are doing dumb things.
427
1051000
3000
瘾君子们在做蠢事。
17:50
The truth真相 is that everyone大家 has a different不同 rationale合理.
428
1055000
3000
每个人都有自己的一套逻辑。
17:53
There are as many许多 different不同 ways方法 of being存在 rational合理的
429
1058000
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世上有多少个人
17:55
as there are human人的 beings众生 on the planet行星,
430
1060000
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就有多少种逻辑。
17:57
and that's one of the glories辉煌 of human人的 existence存在.
431
1062000
2000
这是人类的闪光点之一。
17:59
But those ways方法 of being存在 rational合理的
432
1064000
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但是种种不同的逻辑
18:01
are not independent独立 of one another另一个,
433
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2000
并不是单存于世。
18:03
so it's rational合理的 for
434
1068000
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所以瘾君子们
18:05
a drug药物 injector注射器 to share分享 needles
435
1070000
2000
共用针头很理性
18:07
because of a stupid decision决定 that's made制作 by a politician政治家,
436
1072000
3000
因为政治家的一个愚蠢的决定,
18:10
and it's rational合理的 for a politician政治家
437
1075000
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政治家做了愚蠢的决定
18:12
to make that stupid decision决定
438
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也很理智
18:15
because they're responding响应 to
439
1080000
2000
因为他们是以他们认为的
18:17
what they think the voters选民 want.
440
1082000
2000
投票者赞同的方式行动。
18:19
But here's这里的 the thing:
441
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但问题是:
18:21
we are the voters选民.
442
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我们才是投票者。
18:23
We're not all of them, of course课程, but TEDTED is a community社区 of opinion意见 leaders领导者.
443
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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,
18:26
And everyone大家 who's谁是 in this room房间,
444
1091000
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每个在这间房间的人,
18:28
and everyone大家 who's谁是 watching观看 this out there on the web卷筒纸,
445
1093000
3000
每个在网站上看这些视频的人,
18:31
I think, has a duty义务 to demand需求 of their politicians政治家
446
1096000
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都有义务要求政客们
18:34
that we make policy政策 based基于 on scientific科学 evidence证据
447
1099000
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在科学证据和常识的基础上
18:37
and on common共同 sense.
448
1102000
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指定政策。
18:39
It's going to be really hard for us
449
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我们很难
18:41
to individually个别地 affect影响 what's rational合理的
450
1106000
3000
单独地去影响
18:44
for every一切 Frankie弗兰基 and every一切 Ines伊内斯 out there,
451
1109000
2000
世界上每个Frankie和Ines的决定。
18:46
but you can at least最小 use your vote投票
452
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但是你至少能利用手中的投票权
18:49
to stop politicians政治家 doing stupid things
453
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去阻止政客们做蠢事
18:52
that spread传播 HIVHIV.
454
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加剧HIV的传播。
18:54
Thank you.
455
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谢谢。
18:56
(Applause掌声)
456
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(掌声)
Translated by Elena YAN
Reviewed by Chunlei Chang

▲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

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