PBS高端访谈:旧金山将如何完成降低感染艾滋病人数的宏伟计划?

 　　JOHN CARLOS FREY: At Ward¹ 86, a bustling² outpatient HIV clinic at San Francisco General Hospital, nurse Diane Jones drops everything when this pager goes off.

　　It means that someone in the city just tested HIV positive.

　　DIANE JONES: So, I'm going to make him an appointment.

　　Jones is following a protocol³ called ‘RAPID' which is designed to get new HIV positive individuals into treatment immediately.

　　DIANE JONES: Just got diagnosed today, last negative was June.

　　JOHN CARLOS FREY: Jones scrambles⁵ to make plans for the new patient who is seen just hours later.

　　It's part of an ambitious plan in San Francisco to completely end new HIV infections.

　　Each year about 50,000 people in the United States are infected with HIV. And while the disease has moved off the front pages as treatment has made infection more of a manageable chronic⁶ condition, an estimated 13,700 people still die from AIDS in the U.S. each year.

　　Globally, an estimated 1.5 million people are killed. It's the 6th leading cause of death.

　　In San Francisco there are relatively⁷ few new HIV infections — 359 in 2013 and overwhelmingly found in gay men. It's a number that has been falling over the past eight years. But new infections haven't gone away.

　　Today, public health officials, doctors, and activists⁸ are increasing their efforts to bring that number all the way down to zero.

　　DIANE HAVLIR: We are talking about ending the HIV epidemic⁹.

　　JOHN CARLOS FREY: Dr. Diane Havlir is chief of the HIV/AIDS division at San Francisco General Hospital and a founder¹⁰ of the city's ‘Getting to Zero' Consortium.

　　DIANE HAVLIR: HIV is one of the worst epidemics¹¹ of its time. It's taken a huge toll¹² on our city, a huge toll all around the world. We know how to prevent this disease, we know how to treat this disease. So why would we not want to prevent every single infection, and prevent every single death?

　　JOHN CARLOS FREY: In San Francisco, which has spent $400 million dollars fighting HIV over the last decade, this plan calls for controversial new drugs as well as established prevention strategies. But it starts with immediate⁴ treatment for new HIV infections.

　　DIANE HAVLIR: It did, okay.

　　JOHN CARLOS FREY: One of Dr. Havlir's patients, Jose, who is openly gay but asked that we conceal¹³ his identity because his family doesn't know about his health issue, went through the ‘RAPID' protocol when he was diagnosed with HIV almost a year ago.

　　DIANE HAVLIR: Say Ahhhh.

　　Within 24 hours of being diagnosed Jose was here at Ward 86, and days later receiving HIV medication.

　　JOSE: I was on medication on the third day. And undetectable within less than 30 days.

　　JOHN CARLOS FREY: Undetectable, meaning his HIV viral load had been reduced by medication to the point where it couldn't be detected. And the faster a new patient is undetectable, the faster he reduces his chance of transmitting the virus to others.

　　In San Francisco, about two-thirds of HIV positive individuals are virally suppressed, like Jose, more than double the national average. But that requires an enormous effort.

　　SANDRA TORRES: They might end up in the hospital, that's when we're going to meet them again.

　　JOHN CARLOS FREY: We followed social worker Sandra Torres on the bus as she checked up on a few patients who needed extra help keeping up with their appointments. She and other social workers are continually tracking people down.

　　SANDRA TORRES: We're going to knock on the door.

　　JOHN CARLOS FREY: In the gritty Tenderloin district we went to a single-room occupancy hotel where an HIV positive patient was staying. He's an intravenous drug user and not taking medication.

　　SANDRA TORRES: Hi Honey, how you doing?

　　JOHN CARLOS FREY: Torres dropped off an appointment reminder¹⁴ and I asked her about the patient afterward¹⁵.

　　JOHN CARLOS FREY: It seems like an enormous effort for one person.

　　SANDRA TORRES: That's what it's gonna take, though. That is absolutely what it's gonna take.

　　JOHN CARLOS FREY: But in San Francisco, getting to zero is also banking¹⁶ on the expanded use of a new tool: a drug that protects individuals from becoming infected with HIV.

　　It's called Truvada.

　　SCOTT WIENER: If you take the pill once a day, and you take it consistently, you will reduce your risk of HIV infection by, at least, 90%, and perhaps as high as 99%.

　　JOHN CARLOS FREY: Scott Wiener is an elected city supervisor¹⁷ and a member of the ‘Getting to Zero' consortium.

　　SCOTT WIENER: It just makes sense for people to consider-this additional prevention tool. It made sense for me. And I'm I'm glad that I'm on it.

　　JOHN CARLOS FREY: Wiener, who represents the largely gay Castro district and who is gay himself, went public about his own use of the drug regimen last Fall and makes taking the once-a-day-pill part of his routine each morning.

　　SCOTT WIENER: My decision to disclose is really to raise awareness¹⁸, so more people know about it and look into it, to try to increase access and provide momentum– for better access and to try to reduce stigma¹⁹. So whatever stereotypes²⁰ people have, maybe we can help break those stereotypes.

　　JOHN CARLOS FREY: Including the stereotypes raised by some critics that taking a pill that prevents HIV infection would lead to more promiscuous²¹ behavior.

　　JOHN CARLOS FREY: We're talking about a drug that in some circles has a stigma of opening the door to a free-wheeling sex society. HIV's no longer a threat and we don't have to worry about unprotected sex. Do you get any of that backlash?

　　SCOTT WIENER: There are some people who have that view. And it's really the same argument as when people would argue if you give women access to the birth control pill, you're just gonna encourage them to be promiscuous.

　　Or if you vaccinate²² young girls against HPV you're gonna turn them into, I think one person said, “You'll turn them into nymphomaniacs.”

　　Or if you give sex ed to high-school students or middle-school students you're gonna encourage them to be promiscuous. These are completely specious²³ arguments. This is about giving people every tool available to protect their sexual health.

　　JOHN CARLOS FREY: The use of Truvada for HIV prevention was approved by the FDA in July 2012. The Centers for Disease Control issued guidelines in May of last year recommending the drug for those with substantial risk of HIV infection.

　　In San Francisco, researchers believe that wider adoption²⁴ of the drug could dramatically reduce new HIV infections, but so far only a few thousand San Franciscans have taken the drug in the last year.

　　So why isn't the use of this drug more widespread?

　　There are some side effects, as well as speculation²⁵ that doctors may be hesitant to prescribe a preventative drug to healthy patients, and then there's the price. Although covered by most insurance, Truvada, is listed at more than $1000 a month

　　Even so, it's not nearly the solution that its proponents²⁶ make it out to be according to Michael Weinstein, president of the AIDS Healthcare Foundation, one of the largest AIDS organizations in the world.

　　MICHAEL WEINSTEIN: I think the evidence shows that it is not a good public health strategy.

　　JOHN CARLOS FREY: Why is that?

　　MICHAEL WEINSTEIN: Well, because people don't adhere.

　　JOHN CARLOS FREY: While studies have shown that the regimen can be over 90% effective when taken everyday, Weinstein points out that the efficacy drops off when people miss their daily dose. He also says that relying on a pill instead of a condom may lead to a rise in other sexually transmitted diseases.

　　MICHAEL WEINSTEIN: The motivation that people have for taking Truvada is to be able to have sex without a condom.

　　JOHN CARLOS FREY: Do you think that people don't want to wear condoms either?

　　MICHAEL WEINSTEIN: I think men in general don't wanna wear condoms. That's just an absolute truth. I mean, and it's not surprising. But, you know, we don't wear seatbelts either, you know, or helmets or a lot of other things. But they're a necessity.

　　JOHN CARLOS FREY: So wouldn't it be better then, to just take a pill every day instead of worrying about transmitting H.I.V.?

　　MICHAEL WEINSTEIN: You know what? If it was guaranteed that everybody would take it every day as prescribed. Obviously our attitude about it would be completely different if we didn't have to rely on the person to take that pill every single day.

　　JOHN CARLOS FREY: San Francisco Department of Public Health Chief Barbara Garcia says the city is working to make sure the drug is taken as prescribed, and that doesn't lead to other safe sex practices being abandoned.

　　BARBARA GARCIA: We have already started in trying to educate young people, particularly about this. And that's one of the challenges of having even if we had a cure, that would be the same challenge we would have.

　　JOHN CARLOS FREY: Do you see that happening though? I mean, obviously, if you're having unsafe sex, you're going to be transmitting other sexually-transmitted diseases here

　　BARBARA GARCIA: And, in fact, we've seen a little bit of a rise in S.T.D. here in San Francisco. And we're addressing that as well.

　　JOHN CARLOS FREY: It's not clear that an increase in STDs is related to an increase in the use of Truvada. And Garcia is committed to the drug regimen being a part of ‘Getting to Zero' in San Francisco. And believes that the city's approach to ending HIV, including the lives and money it will save, will eventually trump²⁷ any controversy²⁸.

　　JOHN CARLOS FREY: You can prove to them that you can save money by your model?

　　BARBARA GARCIA: Absolutely. An H.I.V. prevention versus²⁹ an H.I.V. positive client in care, yes, we can.

　　JOHN CARLOS FREY: San Francisco has made tremendous advances in battling an epidemic that his this city harder than most. And according to Dr. Havlir actually getting to zero is within reach.

　　DIANE HAVLIR: I think we would all acknowledge that it is going to be difficult to do, but I think if, as we say, if anybody can do it, we think that we can show people how it can be done starting here.

1 ward   

n.守卫，监护，病房，行政区，由监护人或法院保护的人（尤指儿童）；vt.守护，躲开

参考例句：

• The hospital has a medical ward and a surgical ward.这家医院有内科病房和外科病房。
• During the evening picnic,I'll carry a torch to ward off the bugs.傍晚野餐时，我要点根火把，抵挡蚊虫。

2 bustling   

adj.喧闹的

参考例句：

• The market was bustling with life. 市场上生机勃勃。
• This district is getting more and more prosperous and bustling. 这一带越来越繁华了。

3 protocol   

n.议定书，草约，会谈记录，外交礼节

参考例句：

• We must observe the correct protocol.我们必须遵守应有的礼仪。
• The statesmen signed a protocol.那些政治家签了议定书。

4 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。

5 scrambles   

n.抢夺( scramble的名词复数 )v.快速爬行( scramble的第三人称单数 )；攀登；争夺；（军事飞机）紧急起飞

参考例句：

• The breaking of symmetry scrambles the underlying order of nature. 对称性的破坏会打乱自然界的根本秩序。 来自互联网
• The move comes as Japan scrambles for ways to persuade women to have more babies. 这一行动的出现正值日本政府想尽各种办法鼓励妇女多生育孩子。 来自互联网

6 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

7 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

8 activists   

n.（政治活动的）积极分子，活动家( activist的名词复数 )

参考例句：

• His research work was attacked by animal rights activists . 他的研究受到了动物权益维护者的抨击。
• Party activists with lower middle class pedigrees are numerous. 党的激进分子中有很多出身于中产阶级下层。 来自《简明英汉词典》

9 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

10 Founder   

n.创始者，缔造者

参考例句：

• He was extolled as the founder of their Florentine school.他被称颂为佛罗伦萨画派的鼻祖。
• According to the old tradition,Romulus was the founder of Rome.按照古老的传说，罗穆卢斯是古罗马的建国者。

11 epidemics   

n．流行病

参考例句：

• Reliance upon natural epidemics may be both time-consuming and misleading. 依靠天然的流行既浪费时间，又会引入歧途。
• The antibiotic epidemics usually start stop when the summer rainy season begins. 传染病通常会在夏天的雨季停止传播。

12 toll   

n.过路(桥)费；损失，伤亡人数；v.敲(钟)

参考例句：

• The hailstone took a heavy toll of the crops in our village last night.昨晚那场冰雹损坏了我们村的庄稼。
• The war took a heavy toll of human life.这次战争夺去了许多人的生命。

13 conceal   

v.隐藏，隐瞒，隐蔽

参考例句：

• He had to conceal his identity to escape the police.为了躲避警方，他只好隐瞒身份。
• He could hardly conceal his joy at his departure.他几乎掩饰不住临行时的喜悦。

14 reminder   

n.提醒物，纪念品；暗示，提示

参考例句：

• I have had another reminder from the library.我又收到图书馆的催还单。
• It always took a final reminder to get her to pay her share of the rent.总是得发给她一份最后催缴通知，她才付应该交的房租。

15 afterward   

adv.后来；以后

参考例句：

• Let's go to the theatre first and eat afterward. 让我们先去看戏，然后吃饭。
• Afterward,the boy became a very famous artist.后来，这男孩成为一个很有名的艺术家。

16 banking   

n.银行业，银行学，金融业

参考例句：

• John is launching his son on a career in banking.约翰打算让儿子在银行界谋一个新职位。
• He possesses an extensive knowledge of banking.他具有广博的银行业务知识。

17 supervisor   

n.监督人，管理人，检查员，督学，主管，导师

参考例句：

• Between you and me I think that new supervisor is a twit.我们私下说，我认为新来的主管人是一个傻瓜。
• He said I was too flighty to be a good supervisor.他说我太轻浮不能成为一名好的管理员。

18 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

19 stigma   

n.耻辱，污名；(花的)柱头

参考例句：

• Being an unmarried mother used to carry a social stigma.做未婚母亲在社会上曾是不光彩的事。
• The stigma of losing weighed heavily on the team.失败的耻辱让整个队伍压力沉重。

20 stereotypes   

n.老套，模式化的见解，有老一套固定想法的人( stereotype的名词复数 )v.把…模式化，使成陈规( stereotype的第三人称单数 )

参考例句：

• Such jokes tend to reinforce racial stereotypes. 这样的笑话容易渲染种族偏见。
• It makes me sick to read over such stereotypes devoid of content. 这种空洞无物的八股调，我看了就讨厌。 来自《现代汉英综合大词典》

21 promiscuous   

adj.杂乱的，随便的

参考例句：

• They were taking a promiscuous stroll when it began to rain.他们正在那漫无目的地散步，突然下起雨来。
• Alec know that she was promiscuous and superficial.亚历克知道她是乱七八糟和浅薄的。

22 vaccinate   

vt.给…接种疫苗；种牛痘

参考例句：

• Local health officials then can plan the best times to vaccinate people.这样，当地的卫生官员就可以安排最佳时间给人们接种疫苗。
• Doctors vaccinate us so that we do not catch smallpox.医生给我们打预防针使我们不会得天花。

23 specious   

adj.似是而非的；adv.似是而非地

参考例句：

• Such talk is actually specious and groundless.这些话实际上毫无根据，似是而非的。
• It is unlikely that the Duke was convinced by such specious arguments.公爵不太可能相信这种似是而非的论点。

24 adoption   

n.采用，采纳，通过；收养

参考例句：

• An adoption agency had sent the boys to two different families.一个收养机构把他们送给两个不同的家庭。
• The adoption of this policy would relieve them of a tremendous burden.采取这一政策会给他们解除一个巨大的负担。

25 speculation   

n.思索，沉思；猜测；投机

参考例句：

• Her mind is occupied with speculation.她的头脑忙于思考。
• There is widespread speculation that he is going to resign.人们普遍推测他要辞职。

26 proponents   

n.（某事业、理论等的）支持者，拥护者( proponent的名词复数 )

参考例句：

• Reviewing courts were among the most active proponents of hybrid rulemaking procedures. 复审法院是最积极的混合型规则制定程序的建议者。 来自英汉非文学 - 行政法
• Proponents of such opinions were arrested as 'traitors. ' 提倡这种主张的人马上作为“卖国贼”逮捕起来。 来自辞典例句

27 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

28 controversy   

n.争论，辩论，争吵

参考例句：

• That is a fact beyond controversy.那是一个无可争论的事实。
• We ran the risk of becoming the butt of every controversy.我们要冒使自己在所有的纷争中都成为众矢之的的风险。

29 versus   

prep.以…为对手，对；与…相比之下

参考例句：

• The big match tonight is England versus Spain.今晚的大赛是英格兰对西班牙。
• The most exciting game was Harvard versus Yale.最富紧张刺激的球赛是哈佛队对耶鲁队。