艾滋病的真相（2017）

从小到大 知道自己是同志
Growing up knowing you’re gay,
这种恐惧 从性生活开始活跃起 就萦绕不去
that fear haunts you from the first time you become sexually active.
几乎面对每个性♥伴♥侣♥
You have this guilt and fear and worry and concern
都会产生罪恶、恐惧与担忧的情绪 即使戴了保险套
with almost any sexual partner you have.Even with the condom,
还是对艾滋病毒有莫大的忧虑
there’s still the worry of the big one,which is HIV.
接触前预防性投药 能解除性行为带来的恐惧与担忧
And PrEP takes that fear and that anxiety away from that experience.
好了 哈利
OK,Harry.
我们要看的是 出现一个点表示阴性
We look for that one spot for negative,
两点代表阳性
two spots for positive.
一点 阴性
One spot,negative.
太棒了
Brilliant.
你有什么感觉? 测出阴性 你松了一口气吗?
How do you feel?Are you relieved that the test is negative?
结果是阴性 我当然松一口气
Of course I’m relieved that the result is negative,
但在检验之前 我一点都不焦虑
but I didn’t have any anxiety beforehand either…
真的吗? -因为我知道我已经服药三年
Really?..because I appreciated that I’ve been taking PrEP
所以我感染艾滋病毒的机率
for three years and that the chances of me contracting HIV
几乎不存在
are pretty much non-existent.
最让我觉得惊奇的地方是 在这个小罐子里
The thing that is amazing to me about this is,in this pot,
拥有终结这种流行病的力量
is the power to end the epidemic.
对 我完全同意你的看法
Yes.I mean,I completely agree with you.
这就是我们需要的
This is the thing we need.
去年夏天的伦敦同志大游♥行♥
At last summer’s London Pride Festival,
哈利跟着好几百人 走上街头 发起运动
Harry took to the streets with hundreds of others to campaign
要求国家健保局提供接触前预防性投药
for PrEP to be made available on the NHS.
我们想要什么? -接触前预防性投药 -什么时候要? -现在
What do we want? CROWD: PrEP! When do we want it?Now!
接着 到了2016年
Then,in December 2016,
国家艾滋病信托基金会赢得上诉法♥院♥裁决
the National AIDS Trust won an Appeal Court ruling
英格兰国家健保局和地方政♥府♥
that NHS England and local authorities
有权力资助供应抗逆转滤病毒药物
do have the power to fund the provision of anti-retroviral drugs
以预防感染艾滋病毒
for the prevention of HIV.
因此英国宣布在三年内 将投入一千万英镑进行试验
And so,a £10 million trial over the next three years was announced in
未来在威尔斯也会进行
England,and then a further one in Wales,
苏格兰国家健保局则宣布 今年夏天将供应
whilst NHS Scotland announced that PrEP will be available there
接触前预防性投药 给需要的人
this summer to those who need it.
成本是最大的考量
Cost is a big factor,
英格兰国家健保局要求药厂 以较低价供应药物
and NHS England has challenged drug companies to supply at lower prices.
现在有超过一万人 要加入这项临床试验
Now 10,000 more people will take part in these clinical trials
这些政策为英格兰国家健保局 先前提出的重大问题
to answer what NHS England says are outstanding questions,
找到了解决的出路
paving the way for a full roll-out.
但外界对此问题的关切 并非都是临床上的担忧
But not all views on the subject were based on clinical concerns.
这是每日邮报的一篇报导
So this is an article in the Daily Mail.
新闻标题说 健保局被要求每年提拨价值五千英镑的
Headline is,”NHS told to give out £5,000 a year”
生活型态药物 来预防艾滋病毒 必要的白内障手术却被限制额度
lifestyle drug to prevent HIV as vital cataract surgery is rationed.
“如此扭曲的价值观”
“What a skewed sense of values.”
把它归类为生活型态药物 我认为完全是种误解
Calling it a lifestyle drug,I think,totally misunderstands.
国家健保局治疗的多数疾病
Almost all the conditions we treat in the NHS
只要人们改变生活型态
could be largely prevented
几乎都能预防
if people lived different lifestyles.
我们不会去质疑说 为何要提供
We never have a discussion saying we should not give out
降血压药和降胆固醇药
blood pressure and cholesterol medication
给超重跟不健康的人
to people who are overweight and unfit.
现在却刻意把这种效果极佳的药物 归类为
And to single out this particular highly effective pill as being a
生活型态药物
lifestyle drug…
真的非常恶毒
is really poisonous.
但无论我们对性健康 甚至性道德有什么看法
But whatever our attitudes to sexual health,or even sexual morality,
接触前预防性投药 最近引发热烈讨论
the use of PrEP has been all over the headlines recently,
这确实带来耐人寻味又棘手的问题
and it does raise interesting,difficult questions.
我想问问我老板葛瑞格陶尔斯教授
I wanted to ask my own boss,Professor Greg Towers,
艾滋病毒的顶尖专家 他有什么看法
a leading expert on HIV,what he thought.
你觉得其他人把接触前预防性投药 当成生活型态药物
What you think about the idea that,for a lot of people,PrEP is a
让他们能进行高风险的性行为 怎么看?
lifestyle drug?It allows them to have high-risk sex.
这种药让他们避免感染艾滋病毒 这才是重点
Well,it allows them to not get HIV,which is the point.
我的意思是
I mean,you know,it’s not
我们无权管别人做什么事
our business to be focusing on what people do,
而是要思考如何促进英国民众的健康 而做出决策
it’s about making a decision based on how to improve the health of people in the UK,
如何用最符合成本效益的方式做到这一点
and how to do that in the most cost-effective way.
那些服药的人 如果没感染艾滋病毒 健保局要
Those people taking that drug will cost the NHS less
付出的成本较少
if they don’t get HIV.
他们就会有更多经费治疗病患
There is more money to treat patients if you save money
如果无须让病患终生服用昂贵的药物
through not having to treat people for their entire lives
省的钱更多
with very expensive drugs rather
而不是让病患冒着可能感染艾滋病毒的风险
than for a period where they’re at risk of getting HIV.
当英格兰和威尔斯仿效苏格兰推出
Why aren’t we rolling it out in England and Wales
药物试验计划时 我们还在进行其他试验
in the way they have in Scotland?We’re doing another trial.
我们必须决定发放哪些药
We need to work out what drugs we’re going to give,
还要决定发给哪些人
who we’re going to give them to…
每个人都会服用吗?真正需要的人会服用吗?
Will everybody take it?Will the right people take it?
真正需要的人有渠道取得吗?
Will the right people have access to it?
一定要有正当程序
You have to have due process,
一定要确认执行这个计划是正确的
you have to make sure that this is going to be the appropriate thing to do,
并找出最佳执行的方法
and to work out the appropriate way to do it.
所以这不只是做个小试验 找几百人
So it isn’t like we’re doing a little trial and testing it in a few
来当小白鼠 实际上是要把药物
hundred people.It is actually,in practice,going to be offered
发放给一大群资格符合的人
to quite a large proportion of the eligible population.
对 我不知道合格的人有多少
Yeah.I don’t know how big the eligible population is,but,yeah,
但一万人 他们不会再承受风险
10,000 people is a lot of people who won’t be at risk.
你为什么觉得光靠保险套和个人责任心
So why do you think that condoms and personal responsibility
不足以阻止艾滋病毒的散播?
aren’t enough to stop the spread of HIV?
人们就是不用保险套 有些人反对保险套
People just don’t use them.You know,some people object to using them,
他们就是不想戴 所以我们知道这没用
they don’t want to,so it just doesn’t work.
我不认为这是实际的建议 可防止艾滋病毒扩散
We know that now,and I don’t think that’s a realistic proposition for stopping the spread of HIV.
你认为解药快要问世了吗?
Do you think a cure is on the horizon?
很遗憾 治疗艾滋病毒的有效药物 我认为有很大问题
A cure for HIV is,unfortunately,I think,a big ask at the moment,
因为我们还不够了解病毒的生物结构
because we don’t understand enough about the biology of the virus
还有它和免疫系统的关系
and its relationship with the immune system.
很多专家正在研究
A lot of people are working on it.
绝对有成功的可能
It’s certainly a possibility.
我们能治愈这种病吗?
Will we cure it?
可以尝试
We’re going to try.
(警告 生化危险)
艾滋病毒的真♥相♥是 它的疗法堪称
The truth about HIV is that its treatment has been
医疗史上 最伟大的突破之一
one of the biggest breakthroughs in medical history,
但这种疾病仍尚未根除
but it’s a disease that’s not going away.
还有许多人太晚被诊断出来
And many people are still diagnosed too late.
终点可能已经在望
We have a potential end in sight,
但我们必须洗刷它的污名
but we have to get rid of the stigma
必须消除恨意与羞愧
and we have to get rid of the hate and the shame.
科学已经赋予我们必要的工具 来抵御艾滋病毒
Science has already given us the tools we need to defeat HIV.
这对人类而言是很棒的事
What a fantastic thing for humanity to be able to say,
如果说 “我们能治愈艾滋病”
you know,”We’ve cured HIV.”
就从英国开始 为他国立楷模
Let’s start in the UK.Let’s lead by example.
我们有医药史上最强效的药物
We’ve got some of the most powerful drugs in medicine
让人们能与艾滋病毒健康长久地共存
that mean people can live long,healthy lives with HIV,
更重要的是 他们不再具有感染性
and crucially,they’ll be uninfectious.
我们甚至有口服药物 可预防你感染艾滋病毒
We even have pills that you can take that prevent you catching the virus
至少目前苏格兰健保局已经开始提供
in the first place.Pills that are now available on the NHS,in Scotland at least.
接触前预防性投药的成本 可省下其他治疗的费用
The money you spend on PrEP will save you all that treatment.
在我看来 不发放这些药根本没道理
I mean,it’s like…It doesn’t make any sense not to put it out there.
以成本来看 这是想都不用想的问题
It’s just an economic no-brainer.
在我看来 最大的挑战似乎是 要如何借力于社会
So it seems to me that the remaining challenge is about harnessing social
与政♥治♥决心
and political will
把这些科学突破 做最好的发挥
to put these scientific breakthroughs to best use.
因为如果我们能做到这点 我相信 我们就可以终结这种流行病
Because if we can do that,I believe we can bring the epidemic to an end.