Picture yourself driving

請各位與我一起

down a small road in Africa,

想像你們開著車

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

開在非洲的一條小路上

and this is what you see:

邊開邊注意到路邊的景象

you see a field of graves.

你會發現到的是這個

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

一片墓地

And you go into the town,

然後你會停下來，下車，拍下照片

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

繼續往城鎮開

and people are initially reluctant to tell you.

然後你會問：「這裡發生了什麼事？」

And then someone says,

居民一開始會不願意回答你

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

之後有人會向你坦白

HIV isn't like other medical conditions;

「這些是我們社區，最近因愛滋而死亡的人」

it's stigmatizing.

愛滋不像其他醫療疾病

People are reluctant to talk about it --

得愛滋是種恥辱

there's a fear associated with it.

人們不願意多談

And I'm going to talk about HIV today,

提到愛滋就一陣惶恐

about the deaths,

我今天要談的是，關於愛滋、

about the stigma.

關於死亡、

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

關於恥辱的故事

This map depicts the global distribution of HIV.

這是關於醫療的故事，但更重要的，是關於人們的故事

And as you can see,

這張地圖是全球愛滋分布圖

Africa has a disproportionate share of the infection.

各位可以看到

There are 33 million people

非洲的愛滋感染分佈極不相稱

living with HIV in the world today.

現今有3300萬人

Of these, two-thirds, 22 million

感染愛滋病

are living in sub-Saharan Africa.

這當中有三分之二的人

There are 1.4 million pregnant women

2200萬人住在次撒哈拉非洲地區

in low- and middle-income countries living with HIV

現在有140萬個愛滋媽媽

and of these, 90 percent

來自於中低所得國家

are in sub-Saharan Africa.

其中有九成

We talk about things in relative terms.

就住在次撒哈拉非洲地區

And I'm going to talk about annual pregnancies

我們用相對的例子說明

and HIV-positive mothers.

我要談的是每年的懷孕率

The United States -- a large country --

與愛滋媽媽

each year, 7,000 mothers with HIV

美國這麼大一個國家

who give birth to a child.

每年有七千個愛滋媽媽

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

產下子女

8,000 mothers with HIV who are pregnant.

但你看到盧安達，相對而言很小的國家

And then you go to Baragwanath Hospital,

有8000個懷孕的愛滋媽媽

outside of Johannesburg in South Africa,

當你到巴拉瓜納醫院

and 8,000 HIV-positive pregnant women

就在(南非)約翰尼斯堡附近

giving birth --

醫院裡有約八千名懷孕的愛滋媽媽

a hospital the same as a country.

等著生產

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

光一家醫院的數量就如此龐大

that when you compare

所以請了解，這只是冰山一角

everything here to South Africa, it just pales,

和南非相比

because in South Africa,

南非的情形可是一片慘澹

each year 300,000 mothers with HIV

因為在南非

give birth to children.

每年有30萬個愛滋媽媽

So we talk about PMTCT,

懷孕生子

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

所以我要談PMTCT

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

PMTCT代表：母子垂直感染的預防計畫

that if a mother is HIV-positive,

大家對於愛滋的普遍看法是

she's going to infect her child.

當一名母親感染愛滋

The reality is really, very different.

她的孩子也會受感染

In resource-rich countries,

但事實並非如此

with all the tests and treatment we currently have,

在資源豐富的國家

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

我們已經有許多的測試與療法

98 percent of babies are born HIV-negative.

愛滋寶寶機率只有不到2%

And yet, the reality in resource-poor countries,

98%的寶寶愛滋病毒會呈現陰性反應

in the absence of tests and treatment,

然而在資源短缺國家

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

因為測試與治療的缺乏

40 percent versus two percent --

愛滋寶寶的機率高達40%

an enormous difference.

40%與2%的差距

So these programs --

是非常驚人的

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

所以這些計畫

these prevention programs,

我接下來演講裡所說的PMTCT

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

這些預防計畫

to prevent them from infecting their babies,

簡單說，母親能接受檢查與藥物治療

and also the medicines we give to mothers

來預防垂直感染

to keep them healthy and alive to raise their children.

同時也必須服用藥物

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

讓母親們身體健康到能養育嬰兒

It's the drugs she receives

所以一開始的檢查很重要

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

她要服用的藥很重要

It's the guidance she gets around infant feeding

能讓肚裡的寶寶能健康發育到出生

and safer sex.

嬰兒餵養的指導很重要

It's an entire package of services,

安全性行為也很重要

and it works.

這是關於完善的服務

So in the United States,

而且是有效的

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

在美國

there's been an 80-percent decline

1990年代中期，愛滋的治療出現後

in the number of HIV-infected children.

在愛滋寶寶的數量上

Less than 100 babies are born with HIV

已經降低80%

each year in the United States

美國每年的愛滋寶寶數量

and yet, still,

不到100個

over 400,000 children

然而世界上

are born every year in the world today with HIV.

每年還是有超過40萬名兒童

What does that mean?

一出生就感染愛滋

It means 1,100 children infected each day --

這代表了什麼？

1,100 children each day, infected with HIV.

這代表每天就有1100個孩子受感染

And where do they come from?

每天有1100個孩子感染愛滋

Well, less than one comes from the United States.

這些寶寶從哪來？

One, on average, comes from Europe.

不到一個是來自美國

100 come from Asia and the Pacific.

平均歐洲有一個

And each day,

剩下有一百個來自亞洲、太平洋地區

a thousand babies -- a thousand babies

然而每一天

are born each day with HIV in Africa.

有一千個寶寶，一千個愛滋寶寶

So again, I look at the globe here

在非洲出生

and the disproportionate share of HIV in Africa.

所以我們看看全球情況

And let's look at another map.

在非洲，愛滋分布不均的情況

And here, again, we see

我們來看另一個地圖

Africa has a disproportionate share of the numbers of doctors.

可以再次看到

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

在非洲，醫生數量也是分佈不均

And it's the same with nurses.

圖中那條銀色細線，就是非洲

The truth is sub-Saharan Africa

護士也一樣

has 24 percent

事實上，次撒哈拉非洲地區

of the global disease burden

包含了24%的

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

世界疾病數量

That means doctors and nurses

但醫療人員數量卻只有全世界的3%

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

這表示，這裡的醫生護士

A nurse in a busy clinic

根本沒有時間照顧好每個病人

will see 50 to 100 patients in a day,

較忙的診所裡，每天

which leaves her just minutes per patient --

每位護士要照看50到100位病人

minutes per patient.

一個病人只有幾分鐘時間

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

短短幾分鐘

Well, back in 2001,

當我們看看這些PMTCT計畫，代表了什麼？

when there was just a simple test

我們先回到2001年

and a single dose of a drug,

當時要做的檢查很簡單

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

藥也只有一顆

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

一位護士可以在幾分鐘內

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

提供病人愛滋病諮詢、檢查、

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

解釋檢查結果、發藥(因為只有一顆：Nevirapine)、

and test the baby -- in minutes.

解釋服藥方式、討論嬰兒的服藥選擇、加強嬰兒餵食、

Well, fortunately since 2001,

替嬰兒檢查，幾分鐘內就要完成

we've got new treatments, new tests,

幸運的是，從2001以後

and we're far more successful,

我們有了新治療、新測試

but we don't have any more nurses.

能更加成功地對抗愛滋了

And so these are the tests

但護士還是不夠多

a nurse now has to do

這些測試是

in those same few minutes.

現在的護士

It's not possible --

短短幾分鐘內就要完成的

it doesn't work.

這根本不可能

And so we need to find

根本辦不到

better ways of providing care.

所以我們需要的是

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

提供更好的醫療照顧

mothers coming, pregnant and with their babies.

這照片是非洲一家婦產科診所

These women are here for care,

許多的母親來到這，有懷孕的、帶著孩子的

but we know that just doing a test,

這些婦女來這裡接受照顧

just giving someone a drug,

我們都知道只做測試

it's not enough.

給他們藥物吃

Meds don't equal medical care.

是不夠的

Doctors and nurses, frankly,

藥品不等於醫療照顧

don't have the time or skills

老實說，醫生護士們

to tell people what to do in ways they understand.

根本沒有時間、能力

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

去好好解釋給病人聽

and I expect them to follow my guidance --

我是個醫生，我給病人指示

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

希望他們能照我說的去做

but the reality is,

因為我是個醫生，我哈佛畢業的

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

但事實上

You should always use a condom,"

如果跟病人說：「你要有安全的性行為」

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

「一定要用保險套」

what's going to happen?

但他們的社會裡，女人沒有權利

If I tell her to take her medicines every day

會發生什麼事？

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

如果我告訴她，每天按時服藥

it's just not going to work.

但她家裡沒人知道她生病了又有什麼用

And so we need to do more,

這是行不通的

we need to do it differently,

所以我們必須做更多

we need to do it in ways that are affordable

必須換種方式

and accessible and can be taken to scale,

這方式要我們能夠負擔

which means it can be done everywhere.

能夠接觸到更多人

So, I want to tell you a story --

所以一定要到處都可行

I want to take you on a little trip.

我分享一個故事給各位

Imagine yourself, if you can,

帶你們來趟旅行

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

想想你們自己

You go in for a test

是非洲的一名年輕女性，來到醫院或診所

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

你來做檢查

And then they give you another test

你發現你懷孕了，很開心

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

但他們要你做另一項檢查

And the nurse takes you into a room,

告訴你患有愛滋，你感到很絕望

and she tells you about the tests

然後護士帶你到另一個房間

and HIV and the medicines you can take

她告訴你一些檢查方式、

and how to take care of yourself and your baby,

和需要服用的愛滋藥物

and you hear none of it.

教你如何照顧自己和寶寶

All you're hearing is, "I'm going to die,

你完全聽不進去啊

and my baby is going to die."

你聽到的只有「我快死了」

And then you're out on the street, and you don't know where to go.

「我的寶寶也會死」

And you don't know who you can talk to,

然後你走出診所，沒有目標地晃

because the truth is, HIV is so stigmatizing

你不知道能向誰傾訴

that if you partner, your family, anyone in your home,

因為事實上，染上愛滋是很恥辱的事

you're likely to be thrown out

你的伴侶、家人知道後

without any means of support.

很可能把你趕出家門

And this -- this is the face and story

不給你任何支柱

of HIV in Africa today.

這就是非洲今日

But we're here to talk about possible solutions

對於愛滋病的樣貌

and some good news.

今天要談的是可能的解決方式

And I want to change the story a little bit.

和一些好消息

Take the same mother, and the nurse, after she gives her her test,

我想要換個故事說

takes her to a room.

一樣的母親、護士，在她做完檢查後

The door opens and there's a room full of mothers, mothers with babies,

護士帶她到另一個房間

and they're sitting, and they're talking, they're listening.

門一打開，裡面全是媽媽們，與她們的孩子

They're drinking tea, they're having sandwiches.

他們坐著聊天，彼此傾聽

And she goes inside, and woman comes up to her and says,

他們喝著茶，吃著三明治

"Welcome to mothers2mothers.

她走進去，這些女人們走向她，並說

Have a seat. You're safe here.

「歡迎來到媽媽天地」

We're all HIV-positive.

「請坐下吧，你很安全」

You're going to be okay. You're going to live.

「我們都有愛滋」

Your baby is going to be HIV-negative."

「但我們都會沒事的，你不會死」

We view mothers

「妳的寶寶不會得愛滋的」

as a community's single greatest resource.

我們將母親視為

Mothers take care of the children, take care of the home.

社群裡最有力量的來源

So often the men are gone.

母親們照顧幼小，照顧家園

They're working, or they're not part of the household.

男人常常不在家

Our organization, mothers2mothers,

因為他們需要工作，不管家裡的事

enlists women with HIV

我們的組織「媽媽天地(mothers2mothers)」

as care providers.

讓那些愛滋媽媽

We bring mothers who have HIV,

成為照護人員

who've been through these PMTCT programs

我們請那些有愛滋的母親們來

in the very facilities,

因為她們也經歷過PMTCT計畫

to come back and work side by side with doctors and nurses

熟悉設備

as part of the health care team.

讓她們回來，與醫生護士們一起工作

These mothers, we call them mentor mothers,

就像醫療團隊的一份子

are able to engage women

我們稱這些母親為心靈媽媽

who, just like themselves, pregnant with babies,

她們能夠接觸其他女性

have found out about being HIV-positive,

因為這些女人就像以前的她們一樣，身懷六甲

who need support and education.

因為這些女人剛知道自己得了愛滋

And they support them around the diagnosis

需要支持與教育

and educate them about how to take their medicines,

心靈媽媽能給病患們連續的扶持

how to take care of themselves,

並教導他們如何服藥

how to take care of their babies.

如何照顧自己

Consider: if you needed surgery,

如何照顧孩子

you would want the best possible technical surgeon, right?

想想：如果你需要開刀

But if you wanted to understand

你會找最好的外科醫生，對吧

what that surgery would do to your life,

但如果你想了解

you'd like to engage someone,

手術將造成的影響

someone who's had the procedure.

你想找的會是

Patients are experts on their own experience,

有過同樣手術的病人

and they can share that experience with others.

病人他們自己疾病的專家

This is the medical care that goes beyond just medicines.

他們可以分享自己的經驗

So the mothers who work for us,

這才是所謂藥品以外的醫療照顧

they come from the communities in which they work.

這些替我們工作的母親們

They're hired -- they're paid as professional members of the health care teams,

都來自於自己的社區

just like doctors and nurses.

我們雇用她們，支付與專業醫療人員般的薪水

And we open bank accounts for them

就像醫生、護士

and they're paid directly into the accounts,

我們替他們開銀行帳戶

because their money's protected;

薪水直接匯入銀行

the men can't take it away from them.

如此一來，能保護他們的所得

They go through two to three weeks

讓家中的男人拿不到

of rigorous curriculum-based education, training.

他們必須接受二到三週的

Now, doctors and nurses -- they too get trained.

非常密集教育訓練

But so often, they only get trained once,

醫生護士們也接受訓練

so they're not aware of new medicines,

但通常只有一次而已

new guidelines as they come out.

所以對於新藥品、

Our mentor mothers get trained every single year

新的指導原則都不了解

and retrained.

但心靈媽媽每年接受訓練

And so doctors and nurses --

重新培訓