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HIV/AIDS
艾滋病
A spectre returns
幽靈般的轉(zhuǎn)機
The fall in HIV infections conceals a worrying rise among gay men
艾滋病感染率下降安撫了日益惶恐的男同性戀們
A TELEVISION campaign in the 1980s showed a volcano exploding and dark clouds looming over a blackened tombstone chiselled with the word AIDS. “Don't die of ignorance”, intoned a grim voice. Panic about the HIV/AIDS epidemic was widespread. Now better treatment, and better understanding of how the virus spreads, means that HIV is no longer a death sentence. But amid the good news there is cause for concern; among gay men in Britain infections are rising.
20世紀80年代有一個這樣的電視畫面：火山噴發(fā)，烏云密布，天空下一座黑色的墓碑上刻著“AIDS”（艾滋?。┳謽?。一個冰冷的聲音反復出現(xiàn)“不要死于無知”。人們對艾滋病的惶恐情緒迅速蔓延。而今改善的醫(yī)療技術以及對艾滋病毒傳播途徑更為詳細的理解都使艾滋病不再是死刑的代名詞。但是伴隨著好消息而來的也有些令人擔憂的情況：倫敦男同性戀者中艾滋病感染率上升。
According to statistics released on November 18th by Public Health England (PHE), part of the NHS, 110,000 people in Britain were living with HIV in 2013, the highest number ever. But that is cause for celebration. Those infected are living much longer. People are being tested more often and diagnosed sooner. Between 2004 and 2013 new infections among heterosexuals fell by half.
11月18日英國全民醫(yī)療服務下屬的英格蘭公共衛(wèi)生部門（PHE）公布的數(shù)據(jù)表明，2013年倫敦艾滋病毒攜帶者有110,000人，創(chuàng)下歷史新高。但是也有值得慶祝的事情：這些艾滋病毒攜帶者的壽命將延長。人們接受檢測的頻率增多，也能更快得到治療。2004年到2013年異性戀者之間的艾滋病感染新增人數(shù)減少了一半。
Over the same period, however, the estimated annual number of new infections among men who have sex with men rose by a third, to 3,250. Some 13% of gay men in London are living with HIV. Compare that to San Francisco; the prevalence is higher—fairly static at about 24%—but the rate of new diagnoses is falling. In London, it is rising. This is partly explained by better testing. But reckless behaviour is also to blame.
然而，同期相比，男同性戀者中的艾滋病感染新增人數(shù)增至3250，增加了三分之一。倫敦13%的男同性戀者攜帶有艾滋病毒。相比之下的舊金山，患病人數(shù)就略高一些—大約保持在24%左右—但新診斷的人數(shù)所占比率在下降，而在倫敦，這個數(shù)量卻有所上升。很大程度上得益于更精準的病情監(jiān)測。但是輕率地行徑同樣是病患人數(shù)上升的一大禍源。
“Chemsex”—taking drugs, especially crystal methamphetamine, GBL, or mephedrone, just before or during sex—is the chief innovation. Such drugs fuel sex binges, enabling people to have sex for longer, risking trauma and abrasion, and with a greater number of partners. Both increase the risk of transmission. The internet makes it easier to meet casual partners. David Stuart of 56 Dean Street, an NHS sexual-health clinic in Soho, says the centre sees around 100 gay men every month who use drugs for sex. Most have not had sober sex in six months, he says.
“化學性愛”——在性愛前或性愛后服用毒品，尤其是冰毒， 伽瑪丁內(nèi)酯（GBL）或是甲氧麻黃酮——是主要的誘因。此類藥物刺激性欲，延長人們性愛時間，與大量的同伴性愛更易造成外傷和擦傷，二者都增加了艾滋病傳播的幾率。網(wǎng)絡讓人們更容易接觸到隨意的性愛伙伴。迪恩街56號英國全民醫(yī)療服務性愛健康診療中心的大衛(wèi)·斯圖爾特說，該中心每月大概會接待100位借助藥物進行性愛的男同性戀。大多數(shù)在最近的六個月內(nèi)都是服藥性愛。
Cultural shifts may also be to blame. For some, fear of HIV may manifest itself in avoidance of the subject, via drugs and escapism, says Mr Stuart. But Amrou al-Kadhi, a magazine editor and drag performer, frets that others are in denial. Treatment has so improved that some assume they no longer need worry. He worries that some men treat post-exposure prophylactics like the morning-after pill. (Such medicine may stop infection if taken straight after exposure to HIV.) There is a divide, he suggests, between older gay men, who saw the horrors of the AIDS epidemic, and the young, who seem more complacent.
文化觀念的轉(zhuǎn)變也是一個原因。斯圖爾特表示，對一些人來說，借著毒品和逃避現(xiàn)實，對HIV的恐慌更可能使它變?yōu)橐粋€逃避話題。。但是雜志編輯兼戲劇演員Amrou al-Kadhi擔心其他人不肯接受現(xiàn)實。由于當前醫(yī)療技術進步不小，有人會認為無需擔憂。他擔心有些人將做愛后預防藥看的跟避孕藥似的，盡管此類藥物可能會預防直接暴露于艾滋病后的感染。他建議，經(jīng)歷過艾滋病蔓延的年長男同性戀者和比較自滿的年輕人需要分別對待。
Analysis by Colin Brown, a research fellow at PHE, suggests that testing may not be as widespread as some believe. In 2011, 58% of gay men in Britain said they had been tested for HIV within the past year. But figures from sexual-health clinics in the capital suggest that 20% or less of HIV-negative gay men there get tested every year, half the rate in San Francisco. That city has seen a steeper decline in the proportion of those infected but unaware of it—who are most likely to infect others—than London has.
英格蘭公共衛(wèi)生部門（PHE）的研究員科林·布朗表明測試并不如大家所料的那樣普遍。2011年，英國51%的男同性戀表明在過去的一年里做過艾滋病體檢。但倫敦性愛健康診所的數(shù)據(jù)表明只有20%甚至更低的艾滋病陰性的男同性戀者每年接受艾滋病測試，僅占舊金山的一半。較于倫敦，舊金山感染人數(shù)的比例—這些感染人群更易傳染他人—已經(jīng)驟降，但舊金山卻并未意識到。
Better treatments leave campaigners with a dilemma. They want to see transmissions decline and promote behaviour that minimises risk. But they also want to reassure those who contract HIV that they can still live a long life. Some gay men appear to have taken the second message to heart at the expense of the first.
較高的醫(yī)療水平讓艾滋病活動者進退兩難。他們既想降低艾滋病的感染率，又想宣傳降低感染風險的行為。但是他們也想確保那些已感染了艾滋病毒的人們活的更久些。有一部分同性戀因為關注了那些宣傳行為而感染了艾滋病。譯者：毛慧 校對：張娣
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