TEDxSummit
Shereen El-Feki: HIV -- how to fight an epidemic of bad laws
Shereen El-Feki: 如何對抗敗壞的疾病管制法
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愛滋病不只是個蔓延中的流行病，更伴隨著敗壞的法律條文，將帶病者視為囚犯。在多哈舉辦的這場TEDx高峰會，Shereen El-Feki 提出了強而有力的論證，指出這些將愛滋病汙名化的法律，甚至會助長疾病的擴散。
Shereen El Feki - Arab sexuality expert
Shereen El Feki works and writes on sexuality and social change in the Arab world. Full bio
Shereen El Feki works and writes on sexuality and social change in the Arab world. Full bio
Double-click the English transcript below to play the video.
00:16
Let's begin with a story.
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讓我來講個故事，
00:20
Once upon a time --
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很久很久以前--
00:22
well actually less than two years ago --
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其實是少於兩年前，
00:25
in a kingdom not so very far away,
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在一個不是很遙遠的國度，
00:28
there was a man
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有一個人
00:30
who traveled many miles
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走遍千山萬里
00:31
to come to work at the jewel in the kingdom's crown --
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到鑽石般閃耀的王國求職。
00:35
an internationally famous company.
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那是一間享譽國際的公司，
00:38
Let's call it Island Networks.
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讓我們稱其為《網路島》。
00:41
Now this kingdom had many resources
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這王國現在有很多資源
00:44
and mighty ambitions,
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和強大的野心，
00:46
but the one thing it lacked was people.
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但它缺乏人手。
00:48
And so it invited workers from around the world
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所以，它邀請來自世界各地的工作者
00:52
to come and help it build the nation.
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來幫助它壯大國家。
00:54
But in order to enter and to stay
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但是，若新移民要入境和留在這個國家，
00:57
these migrants had to pass a few tests.
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他們不得不通過幾個測試。
01:01
And so it was, our man presented himself
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就在這時，這個人
01:03
to authorities in the kingdom,
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向王國自薦，
01:05
looking forward to settling into his new life.
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期待開展他的新生活。
01:08
But then something unexpected happened.
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但是，意想不到的事發生了。
01:12
The medical personnel who took blood samples from the man
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幫這個人抽血的醫務人員
01:15
never actually told him what they were testing for.
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從沒有告訴他有關的測試內容；
01:19
He wasn't offered counseling before or after the test,
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也從未在測試之前或之後心理輔導他；
01:23
which is best medical practice.
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這是最有效率的測試方式。
01:25
He was never informed of the results of the test.
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從來沒有人告知過他的測試結果。
01:28
And yet, a couple of weeks later,
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然而數周之後，
01:31
he was picked up and taken to prison
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他被抓起來並關進監獄。
01:34
where he was subjected to a medical exam,
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他被迫進行了一系列醫療測試，
01:36
including a full-body search
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包括全身掃描，
01:39
in full view of the others in the cell.
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其他人可以在外面完全看到他。
01:43
He was released, but then a day or two later,
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他後來被釋放了，但在一至兩天內，
01:46
he was taken to the airport and he was deported.
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他被帶到機場，驅逐出境。
01:51
What on earth did this man do
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這個人到底因為犯了什麼罪
01:55
to merit this treatment?
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而受到這般不人道的待遇？
01:57
What was his terrible crime?
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他的罪行是什麼？
01:59
He was infected with HIV.
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他感染了愛滋病。
02:03
Now the kingdom is one of about 50 countries
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像這樣的王國世界上約有五十個，
02:06
that imposes restrictions on the entry or stay
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對愛滋病毒感染者的入境或逗留
02:10
of people living with HIV.
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設有嚴格限制。
02:13
The kingdom argues
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王國認為
02:15
that its laws allow it to detain or deport foreigners
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法律允許他們扣留或驅逐
02:20
who pose a risk to the economy
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可能對經濟，安全
02:22
or the security or the public health
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公共衛生，或社會道德
02:26
or the morals of the state.
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帶來風險的外國人。
02:28
But these laws, when applied to people living with HIV,
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但這些法律若用在愛滋病患身上，
02:32
are a violation of international human rights agreements
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便違背了國際人權協定，
02:35
to which these countries are signatories.
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而這些國家都是簽署國。
02:38
But you know what?
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但你知道嗎？
02:40
Matters of principle aside,
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把原則問題放一邊，
02:41
practically speaking, these laws drive HIV underground.
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事實上，這些法律導致愛滋病地下蔓延。
02:46
People are less likely to come forth
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人們很少願意表露身分，
02:49
to be tested or treated or to disclose their condition,
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接受測試，治療或揭露自己的狀況，
02:53
none of which helps these individuals
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這樣不只無法保護這些人，
02:56
or the communities these laws purport to protect.
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也危害法律宣稱要保護的社區。
03:00
Today we can prevent the transmission of HIV.
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今天我們可以防止愛滋病毒傳播。
03:04
And with treatment, it is a manageable condition.
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這疾病是可以被藥物控制管理的。
03:07
We are very far from the days
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我們早已不用像遠古時代
03:10
when the only practical response to dread disease
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必須要將帶病者
03:13
was to have banished the afflicted --
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驅逐出境--
03:16
like this, "The Exile of the Leper."
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像這畫"麻瘋病患的流亡"。
03:19
So you tell me why, in our age of science,
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所以你告訴我，為什麼在我們這麼科學的時代，
03:22
we still have laws and policies
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仍有法律和政策
03:25
which come from an age of superstition.
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來自迷信的時代?
03:28
Time for a quick show of hands.
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舉手的時間到了，
03:31
Who here has been touched by HIV --
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在場各位，誰接觸過愛滋病毒--
03:34
either because you yourself have the virus
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無論是你自己感染了，
03:37
or you have a family member or a friend or a colleague
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或你的家人，朋友，同事
03:41
who is living with HIV?
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是愛滋病毒帶原人？
03:43
Hands up.
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請舉起手來。
03:44
Wow. Wow.
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哇，哇，
03:46
That's a significant number of us.
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看來不是小數目。
03:49
You know better than anyone
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你們定比任何人都更明白，
03:52
that HIV brings out
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愛滋病毒，同時引發了
03:54
the best and the worst in humanity.
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人性最光輝也殘酷的一面。
03:57
And the laws reflect these attitudes.
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而法律正好反映出這點。
04:00
I'm not just talking about laws on the books,
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我指的不是只有書上的法律，
04:03
but laws as they are enforced on the streets
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而是街道巷弄裡的不成文法，
04:06
and laws as they are decided in the courts.
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和法院實際判決的法案。
04:09
And I'm not just talking about laws
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我說的這些法律，
04:12
as they relate to people living with HIV,
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不只牽涉到感染愛滋病的人，
04:14
but people who are at greatest risk of infection --
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也涵蓋了處在高風險狀態的人們--
04:17
people such as those who inject drugs or sex workers
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注射毒品者，性工作者，
04:21
or men who have sex with men
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男同性戀者，
04:23
or transgendered persons
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變性人，
04:25
or migrants or prisoners.
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外來移民，或監獄的囚犯。
04:28
And in many parts of the world that includes women and children
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在世界許多地方，婦女和兒童
04:31
who are especially vulnerable.
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更是身處劣勢容易受到傷害。
04:33
Now there are laws in many parts of the world
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現今，有許多地區的法律
04:36
which reflect the best of human nature.
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反映出人性最良善的一面，
04:39
These laws treat people touched by HIV
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同情並且接納
04:43
with compassion and acceptance.
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這些與愛滋病為伍的人們。
04:46
These laws respect universal human rights
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這些法律尊重全體人權，
04:49
and they are grounded in evidence.
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並且以科學證據為根基。
04:52
These laws ensure that people living with HIV
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這些法律確保感染愛滋病毒的人們
04:55
and those at greatest risk
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與那些高風險族群
04:57
are protected from violence and discrimination
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不受暴力和歧視迫害，
05:00
and that they get access to prevention and to treatment.
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並且有管道獲得防治與治療。
05:05
Unfortunately, these good laws
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不幸的是，
05:07
are counter-balanced by a mass
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這些良好法律的功用
05:10
of really bad law --
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被一些建立在道德批判，
05:13
law which is grounded in moral judgement
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恐懼，誤傳等的不良法律
05:17
and in fear and in misinformation,
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給銷抵掉了。
05:20
laws which specifically punish people living with HIV
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這些不良法律，專門懲治
05:24
or those at greatest risk.
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愛滋病毒感染者與那些高風險者。
05:26
These laws fly in the face of science,
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這些有害法律，公然違抗現有科學，
05:28
and they are grounded in prejudice
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把根基建在偏見，無知
05:32
and in ignorance and in a rewriting of tradition
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重蹈覆轍的傳統迷信，
05:35
and a selective reading of religion.
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和斷章取義的宗教典籍上。
05:39
But you know what? You don't have to take my word for it.
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但你知道嗎？你不必相信我的話。
05:41
We're going to hear from two people
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我們來聽另外兩個人的心聲，
05:43
who are on the sharp end of the law.
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他們都直接被這些法律影響。
05:46
The first is Nick Rhoades. He's an American.
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第一個是美國人，Nick Rhoades。
05:48
And he was convicted under the U.S. State of Iowa's law
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根據美國愛荷華州法律，他被定罪了--
05:52
on HIV transmission and exposure --
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罪行： 蓄意散播愛滋病毒--
05:55
neither of which offense he actually committed.
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然而他根本沒有這個意圖。
05:58
(Video) Nick Rhoades: If something is against the law
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（視頻）Nick Rhoades： 被宣判違反法律條文，
06:02
then that is telling society
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就像是在告訴社會大眾
06:03
that is unacceptable, that's bad behavior.
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這是不可接受的不良行為。
06:05
And I think the severity of that punishment
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我認為這種懲罰的嚴重性在於
06:08
tells you how bad you are as a person.
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告訴你你是一個多麼糟糕的人。
06:12
You're a class B felon,
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你是個 B 類重罪犯，
06:14
lifetime sex offender.
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一生都是個性犯罪者。
06:17
You are a very, very, very bad person.
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你是一個非常，非常，非常不好的人。
06:21
And you did a very, very, very bad thing.
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你做了一件非常，非常，非常不好的事情。
06:24
And so that's just programmed into you.
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這就像是精神制約，
06:27
And you go through the correctional system
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你必須接受行為治療，
06:30
and everyone's telling you the same thing.
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且你身邊所有人都像是在說：
06:32
And you're just like, I'm a very bad person.
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你是個很不好的人。
06:37
Shereen El-Feki: It's not just a question
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Shereen El-Fek：這問題的嚴重性
06:39
of unfair or ineffective laws.
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不只是法律的不公正或無效力。
06:42
Some countries have good laws,
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一些國家有良好的法律
06:44
laws which could stem the tide of HIV.
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可以阻止愛滋病毒的蔓延。
06:47
The problem is that these laws are flouted.
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問題是這些法律被藐視了。
06:50
Because stigma gives unofficial license
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愛滋病毒感染者或高風險者
06:53
to treat people living with HIV
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被社會大眾
06:55
or those at greatest risk
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貼上了恥辱的標籤，
06:56
unlike other citizens.
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他們不配當一般公民。
06:59
And this is exactly what happened
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而這正是住在納米比亞的
07:00
to Helma and Dongo from Namibia.
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Helma和Dongo所親身經歷的事情。
07:04
(Video) Hilma: I found out
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（視頻）Helma： 那天我去醫院
07:05
when I went to the hospital for a pregnancy check-up.
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去做妊娠的例行體檢。
07:08
The nurse announced that every pregnant woman
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護士公布每個懷孕的女人
07:12
must also be tested for HIV that day.
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都必須接受愛滋病感染測試。
07:14
I took the test and the result showed I was positive.
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我做了測試，結果表明我被感染了。
07:17
That's the day I found out.
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這天，我得知我是愛滋病患者。
07:20
The nurse said to me, "Why should you people bcome pregnant
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那護士對我說："為什麼你們這種人
07:22
when you know you are HIV positive?
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明明感染愛滋病還要懷孕?
07:24
Why are you pregnant when you are living positive?"
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你們幹嘛要懷孕?"
07:26
I am sure now that is the reason they sterilized me.
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我敢肯定，這是他們消毒我的原因。
07:29
Because I am HIV positive.
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因為我是愛滋病毒陽性。
07:34
They didn't give the forms to me
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他們拿給我一些表格，
07:37
or explain what was in the form.
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沒有做任何解釋，
07:41
The nurse just came with it
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那護士在表格上
07:43
already marked where I had to sign.
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標記我要簽名的欄位，
07:46
And with the labor pain,
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我正經歷分娩的痛楚，
07:47
I didn't have the strength to ask them to read it to me.
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無力要求他們對我解釋那些表格，
07:55
I just signed.
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我就乖乖的簽名了。
07:57
SE: Hilma and Nick and our man in the kingdom
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SE：Helma，Nick和那個故事中的主角，
08:00
are among the 34 million people living with HIV
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根據統計，是世界上3千4百萬愛滋病感染者
08:05
according to recent estimates.
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其中的一員。
08:07
They're the lucky ones
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他們是幸運的，
08:09
because they're still alive.
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因為他們還活著。
08:10
According to those same estimates,
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根據相關估計，
08:12
in 2010 1.8 million people died
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2010年有1百80萬人
08:16
of AIDS related causes.
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死於愛滋病。
08:19
These are terrible and tragic figures.
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這些數字令人驚恐。
08:22
But if we look a little more broadly into the statistics,
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但如果我們更詳細的看這些統計，
08:26
we actually see some reason for hope.
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我們可以找到一絲希望的曙光。
08:30
Looking globally, the number of new infections of HIV is declining.
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綜觀全球，新的愛滋病感染人數，
08:35
And looking globally as well,
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與愛滋病死亡人數，
08:38
deaths are also starting to fall.
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都正在下降。
08:41
There are many reasons for these positive developments,
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有很多原因促進這個發展，
08:43
but one of the most remarkable
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其中一個最引人注目的
08:45
is in the increase in the number of people around the world
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是越來越多人開始接受
08:48
on anti-retroviral therapy,
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抗轉錄病毒療法，
08:50
the medicines they need to keep their HIV in check.
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這療法可以有效抑制愛滋病毒發作。
08:55
Now there are still many problems.
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現在，仍有許多問題待解。
08:57
Only about half of the people who need treatment
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只有約一半需要治療的人
09:00
are currently receiving it.
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得到該治療。
09:02
In some parts of the world --
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在世界上有些地方--
09:04
like here in the Middle East and North Africa --
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像在中東和北非--
09:06
new infections are rising and so are deaths.
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新感染病例與死亡人數正在攀升。
09:10
And the money, the money we need
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而我們需要的經費，
09:13
for the global response to HIV,
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對抗全球愛滋病毒的經費，
09:15
that is shrinking.
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卻在萎縮。
09:18
But for the first time
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但，這是第一次，
09:20
in three decades into this epidemic
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從這流行病蔓延的三十年來，
09:23
we have a real chance to come to grips with HIV.
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我們真正有機會來對付愛滋病毒。
09:27
But in order to do that
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為了做到這一點，
09:29
we need to tackle an epidemic of really bad law.
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我們需要對抗這些普遍存在的壞法律。
09:33
It's for this reason
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正是出於這個原因
09:35
that the Global Commission on HIV and the Law,
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聯合國簽署建立了：全球愛滋病法
09:37
of which I'm a member,
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監督委員會，
09:38
was established by the agencies of the United Nations --
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我正是其中的一員，
09:41
to look at the ways that legal environments
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去監督響愛滋病毒感染者
09:44
are affecting people living with HIV
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和那些高風險族群
09:46
and those at greatest risk,
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所處在的法律環境。
09:48
and to recommend what should be done
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並且建議如何
09:50
to make the law an ally, not an enemy,
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使法律不是敵人，是盟友，
09:53
of the global response to HIV.
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共同對抗全球愛滋病毒。
09:56
Let me give you just one example
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讓我給你舉個例子
09:58
of the way a legal environment
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正確的法律環境，
10:01
can make a positive difference.
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可以帶來積極的改變。
10:03
People who inject drugs
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注射毒品的人
10:06
are one of those groups I mentioned.
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是的我提到的族群之一。
10:08
They're at high risk of HIV
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他們是感染愛滋病的高危險群，
10:10
through contaminated injection equipment
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經由受污染的注射設備
10:12
and other risk-related behaviors.
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和其他危險行為而感染。
10:15
In fact, one in every 10 new infections of HIV
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事實上，每10個感染人之中，
10:18
is among people who inject drugs.
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就有一個是毒品注射者。
10:21
Now drug use or possession
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現在毒品濫用或持有
10:24
is illegal in almost every country.
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幾乎在每個國家都是違法的。
10:26
But some countries take a harder line on this than others.
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但一些國家對此採取更強硬的手段。
10:30
In Thailand people who use drugs,
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在泰國，使用毒品，
10:33
or are merely suspected of using drugs,
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或只是受到懷疑有在用毒，
10:36
are placed in detention centers,
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就會被關在羈留中心，
10:38
like the one you see here,
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如同您看到的，
10:40
where they are supposed to clean up.
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他們被迫在此斷毒癮。
10:42
There is absolutely no evidence
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世上絕對沒有任何證據
10:45
to show that throwing people into detention
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指出只要把人關在拘留所
10:47
cures their drug dependence.
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就可以治療毒品依賴。
10:50
There is, however, ample evidence
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反而，有充分的證據顯示，
10:52
to show that incarcerating people
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把人當囚犯監禁，
10:54
increases their risk of HIV and other infections.
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會增加愛滋病毒和其他感染的風險。
10:59
We know how to reduce HIV transmission and other risks
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我們知道如何減少毒品注射者感染愛滋病
11:05
in people who inject drugs.
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與其他疾病的風險。
11:07
It's called harm reduction,
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這是藉由提供
11:09
and it involves, among other things,
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清潔針頭，注射器，
11:10
providing clean needles and syringes,
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提供毒品替代療法，
11:14
offering opioid substitution therapy
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和其他經過驗證
11:16
and other evidence-based treatments
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有療效的治療法，
11:19
to reduce drug dependence.
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來減少藥物依賴性。
11:21
It involves providing information
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另外包括衛生教育，
11:23
and education and condoms
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保險套的使用宣導，
11:25
to reduce HIV transmission,
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提供愛滋病毒檢測，
11:29
and also providing HIV testing
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提供諮詢，
11:31
and counseling and treatment
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都可保護人們
11:33
should people become infected.
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降低感染機率。
11:35
Where the legal environment allows for harm reduction
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這種減低傷害的法律環境
11:38
the results are striking.
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帶來驚人的成效。
11:41
Australia and Switzerland
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澳大利亞和瑞士
11:42
were two countries which introduced harm reduction
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這兩個國家在愛滋病毒傳播的初期，
11:45
very early on in their HIV epidemics,
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就推出減低傷害的法律環境，
11:48
and they have a very low rate of HIV
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它們的毒品注射者感染愛滋病
11:51
among injecting drug users.
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的機率非常低。
11:53
The U.S. and Malaysia
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而美國和馬來西亞
11:55
came to harm reduction a little later,
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較慢推行減低傷害法律環境，
11:58
and they have higher rates of HIV in these populations.
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它們在此有較高的愛滋病毒感染率。
12:02
Thailand and Russia, however,
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至於泰國和俄羅斯，
12:03
have resisted harm reduction
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拒絕推行減低傷害，
12:05
and have stringent laws
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並用嚴酷的刑法，
12:07
which punish drug use.
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來懲治毒品濫用。
12:09
And hey, surprise,
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所以，嘿，
12:10
very high rates of HIV among people who are injecting drugs.
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毒品注射者很多都感染了愛滋病毒。
12:15
At the Global Commission we have studied the evidence,
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我們的委員會已研究證據，
12:18
and we've heard the experiences
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聆聽親身經歷者
12:20
of over 700 people from 140 countries.
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7百多人，涵蓋140 個國家。
12:24
And the trend? Well the trend is clear.
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這個趨勢是很明顯的。
12:27
Where you criminalize people living with HIV
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只要感染者或高風險族群被當成罪犯，
12:30
or those at greatest risk,
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無論何處，
12:31
you fuel the epidemic.
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是對這流行病火上加油。
12:34
Now coming up with a vaccine for HIV
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現在愛滋病毒疫苗，或甚至解藥
12:38
or a cure for AIDS --
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已經快要問世了，
12:40
now that's rocket science.
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這門科學非常複雜。
12:42
But changing the law isn't.
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但改變法律不複雜。
12:44
And in fact, a number of countries are starting to make progress
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事實上，許多國家正如火如荼的
12:47
on a number of points.
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展開改革。
12:48
To begin, countries need to review their legislation
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首先，國家需要審查其立法，
12:52
as it touches HIV and vulnerable groups.
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因為它涉及到愛滋病與弱勢群體。
12:56
On the back of those reviews,
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審查之餘，
12:58
governments should repeal laws
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各國政府應廢除那些
13:00
that punish or discriminate against people living with HIV
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懲罰或歧視愛滋病毒感染，與高風險者
13:03
or those at greatest risk.
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的不良法律。
13:05
Repealing a law isn't easy,
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廢除法律並非易事，
13:08
and it's particularly difficult
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且變得格外困難
13:09
when it relates to touchy subjects like drugs and sex.
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當它涉及毒品和性別等敏感話題。
13:14
But there's plenty you can do while that process is underway.
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但，在這進程中，我們能做很多事。
13:17
One of the key points is to reform the police
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其中一個關鍵點，是警方的改良。
13:22
so that they have better practices on the ground.
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使他們在法律改革中有更好表現。
13:24
So for example, outreach workers
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例如那些分發保險套
13:26
who are distributing condoms to vulnerable populations
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到弱勢族群的外展工作人員，
13:29
are not themselves subject to police harassment
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不會自己受到員警騷擾，
13:32
or abuse or arbitrary arrest.
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謾罵或任意逮捕。
13:35
We can also train judges
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我們還可以訓練法官，
13:37
so that they find flexibilities in the law
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讓他們在法律中找到彈性，
13:40
and so that they rule on the side of tolerance
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用寬容來裁定
13:43
rather than prejudice.
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而不是偏見。
13:45
We can retool prisons
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我們可以整備監獄，
13:47
so that HIV prevention and harm reduction
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預防，與減少愛滋病毒危害
13:50
is available to prisoners.
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監獄裡的囚犯。
13:52
The key to all this is reinforcing civil society.
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最為關鍵的，是加強民間團體的力量。
13:57
Because civil society is key
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因為，民間團體
13:58
to raising awareness among vulnerable groups
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可以幫助弱勢族群意識到
14:01
of their legal rights.
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他們擁有的法律權利。
14:03
But awareness needs action.
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但只有意識是不夠的。
14:05
And so we need to ensure
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我們需要採取行動，
14:06
that these people who are living with HIV
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確保這些愛滋病患者
14:08
or at greatest risk of HIV
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或高風險族群
14:10
have access to legal services
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能有管道獲得法律服務，
14:13
and they have equal access to the courts.
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且確保他們平等出庭的機會。
14:16
And also important is talking to communities
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另外，與社區對話也極為重要。
14:18
so that we change interpretations
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這樣，我們能對宗教與習俗法條
14:21
of religious or customary law,
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從新詮釋，
14:23
which is too often used
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讓它們不再助長
14:25
to justify punishment and fuel stigma.
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不合理的懲罰和歧視。
14:28
For many of us here
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對很多在場的人來說，
14:30
HIV is not an abstract threat.
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愛滋病毒不是個抽象的威脅，
14:33
It hits very close to home.
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它的影響伸手可處。
14:36
The law, on the other hand,
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另一方面，法律，
14:38
can seem remote, arcane, the stuff of specialists,
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看似艱澀，遙遠而神秘，只有專家才懂，
14:43
but it isn't.
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但這不是事實。
14:45
Because for those of us who live in democracies,
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因為對於我們這些生活在有抱負有理想
14:48
or in aspiring democracies,
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的民主國家的人民，
14:50
the law begins with us.
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法律起始於我們。
14:53
Laws that treat people living with HIV
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法律必須起始於平等，
14:56
or those at greatest risk with respect
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無論是對待愛滋病族群
14:58
start with the way that we treat them ourselves: as equals.
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或是對待我們，皆須平等。
15:03
If we are going to stop the spread of HIV in our lifetime,
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如果我們要愛滋病毒在我們這一代停止蔓延，
15:08
then that is the change we need to spread.
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公平法律，就是我們必須發揚的觀念。
15:12
Thank you.
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謝謝。
15:13
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Shereen El Feki - Arab sexuality expertShereen El Feki works and writes on sexuality and social change in the Arab world.
Why you should listen
Dividing her time between London and Cairo, TED Fellow Shereen El Feki works on issues related to health and social welfare in the Arab region -- including intimate attitudes toward sexual (and political) freedoms, as explored in her new book, Sex and the Citadel.
Half-Egyptian and half-Welsh, El Feki was brought up in Canada. She started her professional life in medical science, with a PhD in molecular immunology from the University of Cambridge, and later worked as healthcare correspondent at The Economist. She also is a former vice chair of the United Nations' Global Commission on HIV and Law. While she has worked in regional media as a presenter with the Al Jazeera Network, and continues to write on social issues in the Arab world, her passion lies in projects that aim to better understand, and surmount, the social challenges facing Arabs, particularly young people.
Read a Q&A with Sheeren El Feki on the TED Fellows site.
Shereen El Feki | Speaker | TED.com