今年是艾滋病多少周年(今年是艾滋病多少周年纪念日)

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Thirty years of a disease
艾滋病肆虐30年

The end of AIDS?
艾滋病的终结?

今年是艾滋病多少周年(今年是艾滋病多少周年纪念日)

Thirty years on, it looks as though the plague can now be beaten, if the world has the will to do so
如果全球各国下定决心,30年的努力看似艾滋病可被治愈。

ON JUNE 5th 1981 America’s Centres for Disease Control and Prevention reported the outbreak of an unusual form of pneumonia in Los Angeles. When, a few weeks later, its scientists noticed a similar cluster of a rare cancer called Kaposi’s sarcoma in San Francisco, they suspected that something strange and serious was afoot. That something was AIDS.
1981年6月5日,美国疾病控制和预防中心(America’s Centres for Disease Control and Prevention)报道称,洛杉矶爆发了一种不同寻常的肺炎。随后数周,在注意到一种类似卡波西肉瘤(Kaposi’s sarcoma)的群发性罕见癌症出现在旧金山后,美国疾病控制预防中心的科学家怀疑某种严重的怪病正在来袭,而这就是艾滋病。

Since then, 25m people have died from AIDS and another 34m are infected. The 30th anniversary of the disease’s discovery has been taken by many as an occasion for hand-wringing. Yet the war on AIDS is going far better than anyone dared hope. A decade ago, half of the people in several southern African countries were expected to die of AIDS. Now, the death rate is dropping. In 2005 the disease killed 2.1m people. In 2009, the most recent year for which data are available, the number was 1.8m. Some 5m lives have already been saved by drug treatment. In 33 of the worst-affected countries the rate of new infections is down by 25% or more from its peak.
自此,全球共有2500万人已死于艾滋病,另有3400万人受到感染。艾滋病出现的30周年纪念日被许多人视为紧搓双手而又无计可施的时机。不过,抗艾之战的进展远远好于任何人此前所能想象的。10年前,人们预计非洲南部数个国家将有半数人口死于艾滋病。现在,艾滋病患者的死亡率正在下降。2005年,艾滋病夺走210万人的生命。离当前最近并有数据可查的2009年,这一死亡数字为180万。通过药物治疗,约500万人的性命得到拯救。在艾滋病肆虐最严重的33个国家,艾滋病传染新病例比高峰时期下降了25%或更多。

Even more hopeful is a recent study which suggests that the drugs used to treat AIDS may also stop its transmission (see article). If that proves true, the drugs could achieve much of what a vaccine would. The question for the world will no longer be whether it can wipe out the plague, but whether it is prepared to pay the price.
最近一项研究更是令人充满希望。此项研究表明,抗艾药物也可能阻止了艾滋病的传播。如果此项研究可信的话,这些药物将达到疫苗的大部分效果。全球面临的问题也将不再是艾滋病能否根除,而是人们是否做好支付药价的准备。

The appliance of science
运用科学

If AIDS is defeated, it will be thanks to an alliance of science, activism and altruism. The science has come from the world’s pharmaceutical companies, which leapt on the problem. In 1996 a batch of similar drugs, all of them inhibiting the activity of one of the AIDS virus’s crucial enzymes, appeared almost simultaneously. The effect was miraculous, if you (or your government) could afford the $15,000 a year that those drugs cost when they first came on the market.
如果艾滋病被攻克,这将归功于科学,行动主义和利他主义三者的结合。科学的贡献在于全球制药公司对艾滋病采取了行动。1996年,一批抑制艾滋病关键酶活动的类似药品几乎同时问世。抗艾药品首次进入市场的价格是1.5万美元/年,如果患者(或政府)能承担得起医药费,治疗效果将是不可思议。

Much of the activism came from rich-world gays. Having badgered drug companies into creating the new medicines, the activists bullied them into dropping the price. That would have happened anyway, but activism made it happen faster.
行动主义多数要归功于发达国家的男同性恋者。在死缠烂打要求制药公司研发新药后,行动主义者又要求降低药价。尽管迟早将会发生,但此举受到行动主义的影响反而来得更快。

The altruism was aroused as it became clear by the mid-1990s that AIDS was not just a rich-world disease. Three-quarters of those affected were—and still are—in Africa. Unlike most infections, which strike children and the elderly, AIDS hits the most productive members of society: businessmen, civil servants, engineers, teachers, doctors, nurses. Thanks to an enormous effort by Western philanthropists and some politicians (this is one area where even the left should give credit to George Bush junior), a series of programmes has brought drugs to those infected.
90年代中期,艾滋病不只是发达国家疾病的观念愈加清晰明了,这激起利他主义的产生。3/4的艾滋病感染者曾在并仍在非洲。不同于那些针对儿童老人的大多数传染病,艾滋病的传染对象是社会上最富生产力的人员:商人,公务员,工程师,教师,医生,护士。由于西方慈善家和一些政客(即便是左派在此方面也应给予乔治*布什嘉奖)作出的巨大努力,他们的一系列行动方案为艾滋病感染者带来了抗艾药物。

The result is patchy. Not enough people—some 6.6m of the 16m who would most quickly benefit—are getting the drugs. And the pills are not a cure. Stop taking them, and the virus bounces back. But it is a huge step forward from ten years ago.
结果差强人意。没有足够的人获得到抗艾药物。在本应可最快受益的1600万感染者中,只有600多万人获得药物,而药物还不能根治艾滋病。药物不服,病毒反复。但这同10年前相比已是一个巨大进步。

What can science offer now? A few people’s immune systems control the disease naturally (which suggests a vaccine might be possible) and antibodies have been discovered that neutralise the virus (and might thus form the basis of AIDS-clearing drugs). But a cure still seems a long way off. Prevention is, for the moment, the better bet.
科学现在可带来什么?人类自身免疫系统几乎无法抵抗艾滋病(而这表明疫苗注射是有可能奏效的),而中和艾滋病病毒的抗体(并有可能是构成治愈艾滋病药物的基础)已被发现。但治愈艾滋病看似还有很长的路要走。目前而言,预防是最好的选择。

There are various ways to stop people getting the disease in the first place. Nagging them to use condoms and to sleep around less does have some effect. Circumcision helps to protect men. A vaginal microbicide (none exists, but at least one trial has gone well) could protect women. The new hope centres on the idea of combining treatment with prevention.
从根本上而言,防止感染艾滋病的方法有很多。反复宣传使用避孕套和不搞多性关系确实有一定的效果。包皮环切有助于保护男士。阴道杀菌剂(尽管尚不存在,但至少有一项试验进展顺利)可保护妇女。治疗同预防相结合的理念带来了新的希望。

A question of money
金钱问题

In the early days scientists were often attacked by activists for being more concerned with trying to prevent the epidemic spreading than treating the affected. Now it seems that treatment and prevention will come in the same pill. If you can stop the virus reproducing in someone’s body, you not only save his life, you also reduce the number of viruses for him to pass on. Get enough people on drugs and it would be like vaccinating them: the chain of transmission would be broken.
早期,活动家往往指责科学家过于注重阻止艾滋病疫情的蔓延,而非治疗艾滋病患者。现在看来,治疗和预防具备相同的药效。如果可以阻止病毒在人体内繁殖,艾滋病患者的生命不仅可得到拯救,而且病毒传播的数量也会减少。确保足够多的患者获得到药品,这将会起到注射疫苗的类似效果:艾滋病传播链将会被打破。

That is a huge task. It is not just a matter of bringing in those who should already be on the drugs (the 16m who show symptoms or whose immune systems are critically weak). To prevent transmission, treatment would in theory need to be expanded to all the 34m people infected with the disease. That would mean more effective screening (which is planned already), and also a willingness by those without the symptoms to be treated. That willingness might be there, though, if it would protect people’s uninfected lovers.
这是一项艰巨的任务。这不仅仅是一个向艾滋病患者(有1600万患者表现出艾滋病症状或自身免疫系统非常脆弱)提供药品的问题。理论上说,为阻止艾滋病的传播,治疗需要将范围扩展到3400万的所有艾滋病感染者。这将意味着要对是否患有艾滋病的人群进行更有效的检查(已在构想当中),尚未出现艾滋病症状的人们也愿意接受治疗。如果此举可以保护到未受艾滋病传染的爱人,人们理应自愿接受配合。

Such a programme would take years and also cost a lot of money. About $16 billion a year is spent on AIDS in poor and middle-income countries. Half is generated locally and half is foreign aid. A report in this week’s Lancet suggests a carefully crafted mixture of approaches that does not involve treating all those without symptoms would bring great benefit for not much more than this—a peak of $22 billion in 2015, and a fall thereafter. Moreover, most of the extra spending would be offset by savings on the treatment of those who would have been infected, but were not—some 12m people, if the boffins have done their sums right. At $500 per person per year, the benefits would far outweigh the costs in purely economic terms; though donors will need to compare the gain from spending more on knocking out AIDS against other worthy causes, such as eliminating malaria (see article).
此项方案将需要花费数年时间,也将耗费大量金钱。在贫穷和中等收入国家,抗击艾滋病需要大约160亿美元。这笔款项一半需要本国解决,另一半需要外国援助。本周,英国《柳叶刀》医学杂志提出,在全球总开支不高于2015年220亿美元峰值的前提下,一种集各种疗法的精心组合(不含治疗那些尚未患艾滋病症状人群的费用)将会给广大患者带来极大好处。如果科研人员估算准确的话,用在那些可能会被感染但实际上并未感染 “患者”(约有1200万人)的治疗费用将会节省下来,大多数额外开支将同这笔节省费用抵消。每位患者每年花费500美金,这所获取的收益将不仅仅只是经济方面的。尽管在抗击艾滋病进行更多投资时,捐助者还会对比在其他有价值项目(如消除疟疾)所获取的收益。

For the moment, the struggle is to stop some rich countries giving less. The Netherlands and Spain are cutting their contributions to the Global Fund, one of the two main distributors of the life-saving drugs (the other is Mr Bush’s brainchild, PEPFAR), and Italy has stopped paying altogether.
当下的奋斗目标是要阻止一些发达国家减少援助资金。荷兰和西班牙在向全球基金(Global Fund)削减援助资金数目。全球基金是艾滋病救命药物的两大主要分销商(另一主要分销商是乔治*布什设立的总统救助艾滋病应急计划)之一,而意大利完全停止资助。

On June 8th the United Nations meets to discuss what to do next. Those who see the UN as a mere talking-shop should remember that its first meeting on AIDS launched the Global Fund. It is still a long haul. But AIDS can be beaten. A plague that 30 years ago was blamed on man’s iniquity has ended up showing him in a better, more inventive and generous light.
6月8日,联合国举行会议商讨下一步如何操作。那些认为联合国只是一个聊天室的人们应该不会忘记,联合国在首次讨论艾滋病的会议上启动了全球基金组织。尽管这是一项长期而艰巨的任务,但艾滋病是可被攻克的。一场在30年前被归咎于人类罪恶的瘟疫已从一个更加美好,较为创新和极为无私的角度终结。

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