with some of the clearest water and bluest skies on the planet.

菲律賓這個國家有著田園風光，

It is also the epicenter

以及地球上一部分 最清澈的水和最藍的天。

of one of the fastest-growing HIV epidemics in the world.

它也是世界上愛滋病病毒傳播最快的

On the surface, it seems as if we are just a late bloomer.

區域中心之一。

However, the reasons for our current epidemic

表面上看起來， 似乎我們只是遲開的花朵。

are much more complicated

然而，目前我們的病毒如此流行，

and may foreshadow a global resurgence of HIV.

背後的原因複雜很多，

While overall new cases of HIV continue to drop in the world,

且有可能是愛滋病病毒 於全球捲土重來的前兆。

this trend may be short-lived

雖然全世界愛滋病 新病例的數量在持續下降，

when the next wave of more aggressive and resistant viruses arrive.

但這個趨勢可能很短暫，

HIV has a potential to transform itself into a new and different virus

下一波更有侵略性、 更頑強的病毒很快就會到來。

every time it infects a cell.

每當愛滋病病毒感染一個細胞時， 它就有潛力將它自己轉變為

Despite the remarkable progress we've made in reversing the epidemic,

不同的新病毒。

the truth is that we are just a few viral mutations away from disaster.

儘管我們在控制病毒 傳播方面有不錯的進展，

To appreciate the profound way in which HIV transforms itself

真相是，再來幾次病毒突變， 就可能會帶來一場災難。

every time it reproduces,

為了進一步了解愛滋病病毒 每次複製繁殖時

let's make a genetic comparison.

轉化為其他病毒的複雜肌理，

If we look at the DNA variation among humans of different races

讓我們來做一項基因比較。

from different continents,

比較不同大陸、不同人種間的 DNA 差異，

the actual DNA difference is only 0.1 percent.

實際的 DNA 差異只有 0.1%。

If we look at the genetic difference

如果比較的基因差異

between humans, great apes, and rhesus macaques,

是在人類、類人猿以及獼猴之間的，

that number is seven percent.

這個數字為 7%。

In contrast, the genetic difference between HIV subtypes

相對之下，不同病人的 愛滋病病毒亞型之間，

from different patients

基因差異可能高達 35%。

may be as much as 35 percent.

在一個感染了愛滋病病毒的人身上，

Within a person infected with HIV,

研究已發現，在感染他的母病毒

the genetic difference between an infecting mother virus

和後續產生的子病毒之間，

and subsequent daughter viruses

基因差異可高達 5%。

has been shown to be as much as five percent.

這就等同於一隻大猩猩 生出一隻黑猩猩，

This is the equivalent of a gorilla giving birth to a chimpanzee,

然後再生出一隻猩猩，

then to an orangutan,

然後再生出一隻狒狒，

then to a baboon,

然後在其一生中 再生出任何一種類人猿。

then to any random great ape within its lifetime.

一共有近一百種愛滋病病毒亞型，

There are nearly 100 subtypes of HIV,

經常還會發現新的亞型。

with new subtypes being discovered regularly.

在發達國家中的愛滋病病毒 幾乎都是同一種亞型的：

HIV in the developed world is almost all of one subtype:

B 亞型。

subtype B.

在治療愛滋病上， 我們大部分的知識和做法，

Mostly everything we know and do to treat HIV

都以 B 亞型的研究為基礎，

is based on studies on subtype B,

但其實這種亞型只佔了

even though it only accounts for 12 percent

全世界愛滋病案例總數的 12%。

of the total number of cases of HIV in the world.

但，因為不同亞型間的 基因差異非常深奧，

But because of the profound genetic difference

有些亞型比較可能會發展出抗藥性，

among different subtypes,

或是更快發展成愛滋病。

some subtypes are more likely to become drug-resistant

我們發現，在菲律賓的 愛滋病案例大爆發，

or progress to AIDS faster.

背後原因是因為西方的 B 亞型

We discovered that the explosion of HIV cases in the Philippines

轉變為更有侵略性的 東南亞 AE 亞型。

is due to a shift from the Western subtype B

我們發現更年輕、病得更重的病人，

to a more aggressive Southeast Asian subtype AE.

且病毒的抗藥性很高。

We are seeing younger and sicker patients

這種亞型的初始侵入

with high rates of drug resistance.

已經在已發達國家中發生了，

Initial encroachment of this subtype

包括澳洲、加拿大，以及美國。

is already occurring in developed countries,

我們可能很快就會在 這些國家看到病情的集中爆發。

including Australia, Canada and the United States.

雖然我們認為愛滋病已經結束了，

We may soon see a similar explosion of cases in these countries.

局勢已經扭轉，

And while we think that HIV is done

就像真正的浪潮一樣， 它有可能會捲土重來。

and that the tide has turned for it,

在六○年代初， 瘧疾差不多要被消滅了。

just like with real tides, it can come right back.

案例數目減少，

In the early 1960s, malaria was on the ropes.

人們和政府都不再留意。

As the number of cases dropped,

結果卻是具有抗藥性的 瘧疾，致命性地再現。

people and governments stopped paying attention.

我們不能把愛滋病病毒

The result was a deadly resurgence of drug-resistant malaria.

當成一種我們已經研究透徹的東西，

We need to think of HIV

而是要把它當作是一群快速演化

not as a single virus that we think we've figured out,

且非常獨特的病毒，

but as a collection of rapidly evolving and highly unique viruses,

當中每一個病毒都可能 引發下次致命流行。

each of which can set off the next deadly epidemic.

我們正在納入更多新的強大工具，

We are incorporating more powerful and new tools

來協助我們偵測出下一個 致命的愛滋病病毒品種，

to help us detect the next deadly HIV strain,

這需要配合

and this needs to go hand in hand with urgent research

關於非 B 亞型病毒之 行為和適當治療的急迫研究。

on the behavior and proper treatment of non-B subtypes.

我們得要說服我們的政府

We need to convince our governments

以及我們的資助機構，

and our funding agencies

告訴他們，對抗愛滋病的鬥爭 還遠沒有結束。

that HIV is not yet done.

已經有 3500 萬人死於愛滋病。

Over 35 million people have died of HIV.

我們正在一個無愛滋病世代的邊緣。

We are on the verge of an AIDS-free generation.

我們得要多留心。

We need to pay attention.

我們得要保持警惕，

We need to remain vigilant

並堅持到底。

and follow through.

不然，還會有更多的人死於愛滋。

Otherwise, millions more will die.

謝謝。

Thank you.

（掌聲）

(Applause)