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請各位與我一起進行一趟旅程。想像你們開著車,在非洲一條小路上,邊開邊注意路邊的景象,你會看到的是這個,一片墓地。然後你停下來,下車,拍下照片,接著繼續往城鎮開。你問道,「這裡發生了什麼事?」居民一開始不願意回答你,之後有人開口說,「這是我們社區最近因愛滋病死亡的人。」愛滋病不像其他醫療疾病,得愛滋病是種恥辱,人們不願意多談,提到愛滋病就一陣惶恐。我今天要談的是關於愛滋病、死亡與恥辱的故事,這是關於醫療的故事,但更重要的,是關於人們的故事。
這張地圖是全球愛滋病感染分布圖,各位可以看到非洲的愛滋病感染分佈極不成比例。現今全世界有3300萬人感染愛滋病,當中有三分之二,即2200萬人住在撒哈拉以南非洲地區。現在有140萬個愛滋媽媽來自中低所得國家,其中九成住在撒哈拉以南非洲地區。我們用相對的例子說明,我要談的是每年的懷孕率與愛滋媽媽。在美國這麼大一個國家,每年有七千個愛滋媽媽產下子女,但你看盧安達,相對而言很小的國家,有8000個懷孕的愛滋媽媽。當你到南非約翰尼斯堡附近的Baragwanath醫院,醫院裡有八千名懷孕的愛滋媽媽等著生產,光一家醫院的數量就如同一個國家那麼龐大。請瞭解,這個情況和南非相比只是九牛一毛,南非的情形一片慘澹,因為在南非每年有30萬個愛滋媽媽懷孕生子。
所以我要談PMTCT。PMTCT代表母子垂直感染預防計畫,我想大多數人對於愛滋病的普遍看法是,當一名母親感染愛滋,她的孩子也會受感染,但事實並非如此。在資源豐富的國家,最近已經有許多測試與療法,使產下愛滋寶寶的機率不到2%,98%的寶寶愛滋病毒呈現陰性反應。然而在資源短缺國家,因為測試與治療的缺乏,寶寶感染愛滋病的機率高達40%,40%與2%的差距是非常驚人的。所以這些計畫,我接下來要說的PMTCT預防計畫,簡單說,就是母親接受檢查與藥物治療來預防垂直感染,同時也必須服用藥物,讓母親們身體健康並存活,以期能養育嬰兒。一開始母親得接受檢查,並服用能讓肚裡的寶寶健康發育到出生的藥物,並指導如何餵養嬰兒及安全性行為的知識。這是整體的醫療服務,而且很有效。
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以下為系統擷取之英文原文
I want you to take a trip with me. Picture yourself driving down a small road in Africa, and as you drive along, you look off to the side, and this is what you see: you see a field of graves. And you stop, and you get out of your car, and you take a picture. And you go into the town, and you inquire, "What's going on here?" and people are initially reluctant to tell you. And then someone says, "These are the recent AIDS deaths in our community." HIV isn't like other medical conditions; it's stigmatizing. People are reluctant to talk about it. There's a fear associated with it. And I'm going to talk about HIV today, about the deaths, about the stigma. It's a medical story, but, more than that, it's a social story.
This map depicts the global distribution of HIV. And as you can see, Africa has a disproportionate share of the infection. There are 33 million people living with HIV in the world today. Of these, two-thirds, 22 million, are living in sub-Saharan Africa. There are 1.4 million pregnant women in low- and middle-income countries living with HIV, and of these, 90 percent are in sub-Saharan Africa. We talk about things in relative terms. And I'm going to talk about annual pregnancies and HIV-positive mothers. The United States -- a large country -- each year, 7,000 mothers with HIV who give birth to a child. But you go to Rwanda -- a very small country -- 8,000 mothers with HIV who are pregnant. And then you go to Baragwanath Hospital, outside of Johannesburg in South Africa, and 8,000 HIV-positive pregnant women giving birth -- a hospital the same as a country. And to realize that this is just the tip of an iceberg, that, when you compare everything here to South Africa, it just pales, because, in South Africa, each year, 300,000 mothers with HIV give birth to children.
So we talk about PMTCT, and we refer to PMTCT, prevention of mother to child transmission. I think there's an assumption amongst most people in the public that, if a mother is HIV-positive, she's going to infect her child. The reality is really very different. In resource-rich countries, with all the tests and treatment we currently have, less than two percent of babies are born HIV-positive. 98 percent of babies are born HIV-negative. And yet, the reality in resource-poor countries, in the absence of tests and treatment, 40 percent, 40 percent of children are infected -- 40 percent versus two percent -- an enormous difference. So these programs -- and I'm going to refer to PMTCT though my talk -- these prevention programs, simply, they're the tests and the drugs that we give to mothers to prevent them from infecting their babies, and also the medicines we give to mothers to keep them healthy and alive to raise their children. So it's the test a mother gets when she comes in. It's the drugs she receives to protect the baby that's inside the uterus and during delivery. It's the guidance she gets around infant feeding and safer sex. It's an entire package of services, and it works.
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在美國,自從1990年代中期,愛滋病療法出現後,感染愛滋病的寶寶數量已降低了80%,美國每年產下的愛滋寶寶數量不到100個,然而世界上每年還是有超過40萬名兒童一出生就感染愛滋病。這代表了什麼?這代表每天就有1100個孩子受感染,每天有1100個孩子感染愛滋病。這些寶寶從哪來的?來自美國的不到一個,平均有一個來自歐洲,一百個來自亞洲及太平洋地區,然而每一天有一千個寶寶,一千個愛滋寶寶在非洲出生。
因此,我們再看看全球情況及非洲愛滋病分佈不均的情況。我們來看另一張地圖,同樣的,我們看到非洲醫生數量的分佈也不平均。圖中那條銀色細線就是非洲,護士也一樣。事實上,撒哈拉以南非洲地區的疾病發生率佔全世界的24%,但醫療人員數量卻只佔全世界的3%,這表示這裡的醫生及護士根本沒時間照顧好每個病人。在較忙碌的診所裡,每位護士每天要照看50到100位病人,平均能照看一位病人的時間只有幾分鐘-短短幾分鐘。看看這些PMTCT計畫,它意味著什麼?
回頭來看2001年的情形。當時只有一種簡單的檢查,藥也只有一種,一位護士在處理一位病人的幾分鐘時間內,必須勸導病人接受愛滋病測試、進行愛滋病測試、解釋測試結果、並分發單一治療藥物Nevirapine、解釋服藥方式、討論嬰兒餵食選擇、加強對於嬰兒的餵食並替嬰兒進行測試,在幾分鐘內得完成所有的事。幸運的是,從2001年以後,我們有了新療法及新測試法,能更加成功地對抗愛滋病,但護士還是不夠多。這些是現今護士在短短幾分鐘內得完成的測試,這根本不可能,根本辦不到。所以我們必需找出更好的方法來提供醫療照護。
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So in the United States, since the advent of treatment in the middle of the 1990s, there's been an 80-percent decline in the number of HIV-infected children. Less than 100 babies are born with HIV each year in the United States, and yet, still, over 400,000 children are born every year in the world today with HIV. What does that mean? It means 1,100 children infected each day -- 1,100 children each day, infected with HIV. And where do they come from? Well, less than one comes from the United States. One, on average, comes from Europe. 100 come from Asia and the Pacific. And each day, a thousand babies, a thousand babies are born each day with HIV in Africa.
So again, I look at the globe here and the disproportionate share of HIV in Africa. And let's look at another map. And here, again, we see Africa has a disproportionate share of the numbers of doctors. That thin sliver you see here, that's Africa. And it's the same with nurses. The truth is sub-Saharan Africa has 24 percent of the global disease burden, and yet, only three percent of the world's health care workers. That means doctors and nurses simply don't have the time to take care of patients. A nurse in a busy clinic will see 50 to 100 patients in a day, which leaves her just minutes per patient -- minutes per patient. And so when we look at these PMTCT programs, what does it mean?
Well, back in 2001, when there was just a simple test and a single dose of a drug, a nurse, in the course of her few minutes with a patient, would have to counsel for the HIV test, perform the HIV test, explain the results, dispense a single dose of the drug, Nevirapine, explain how to take it, discuss infant feeding options, reinforce infant feeding, and test the baby, in minutes. Well, fortunately, since 2001, we've got new treatments, new tests, and we're far more successful, but we don't have any more nurses. And so these are the tests a nurse now has to do in those same few minutes. It's not possible. It doesn't work. And so we need to find better ways of providing care.
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照片上是非洲的一家婦產科診所,許多母親來到這裡,有懷孕的、帶著孩子的,這些婦女來這裡接受醫療照顧。但我們知道只做測試、給她們藥物吃是不夠的,藥品不等於醫療照護。老實說,醫生護士們根本沒時間或能力,用病人能理解的方式告訴病人該怎麼做。我是個醫生,我給病人指示,希望他們能照我說的去做,因為我是個醫生,我畢業於哈佛。但事實上,如果我跟病人說,「你應進行安全性行為,一定要用保險套。」但如果在交往關係中,她屬於弱勢的一方,會發生什麼情形?如果我告訴她每天按時服藥,但家中沒人知道她的病情呢?這是行不通的。所以我們必須做更多,必須換種方式,我們必須用一種負擔的起、容易達成且普及的方式,這意味著這個方式在任何地方都適用。
所以我想與各位分享一個故事,帶你們進行一段旅程。可以的話,想像自己是一位年輕的非洲女性,打算到醫院或診所進行檢查,你發現自己懷孕了,很開心,但他們替你做另一項檢查,告訴你你患有愛滋病,你感到很絕望,然後護士將你帶到一個房間,告訴你一些關於這個測試、愛滋病及可服用藥物的事,教你如何照顧自己和寶寶,你完全聽不進去,你聽到的只有,「我快死了,我的寶寶也會死。」然後你走出診所,不知何去何從,不知能向誰傾訴。因為事實是,染上愛滋病是很恥辱的事,你的伴侶及家人知道後,很可能把你趕出家門,不會有任何支持你的行動,這就是現今愛滋病患在非洲面臨的情況。
但我們今天要談的是可能的解決方式和一些好消息。我想將這個故事做些變動,同樣的母親、護士,護士替她做完檢查後,將她帶到一個房間,門一打開,裡面全是媽媽與她們的孩子,她們坐著聊天,彼此傾聽;她們喝著茶,吃著三明治;她走進去,這些女人走向她,並說,「歡迎來到媽媽互助天地,請坐下吧,妳在這裡很安全,我們都有愛滋病,妳不會有事的,妳不會死,妳的寶寶不會得愛滋病的。」
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This is a picture of a maternal health clinic in Africa -- mothers coming, pregnant and with their babies. These women are here for care, but we know that just doing a test, just giving someone a drug, it's not enough. Meds don't equal medical care. Doctors and nurses, frankly, don't have the time or skills to tell people what to do in ways they understand. I'm a doctor. I tell people things to do, and I expect them to follow my guidance -- because I'm a doctor; I went to Harvard -- but the reality is, if I tell a patient, "You should have safer sex. You should always use a condom," and yet, in her relationship, she's not empowered -- what's going to happen? if I tell her to take her medicines every day, and yet, no one in the household knows about her illness, so it's just not going to work. And so we need to do more, we need to do it differently, we need to do it in ways that are affordable and accessible and can be taken to scale, which means it can be done everywhere.
So, I want to tell you a story. I want to take you on a little trip. Imagine yourself, if you can, you're a young woman in Africa, you're going to the hospital or clinic. You go in for a test, and you find out that you're pregnant, and you're delighted. And then they give you another test, and they tell you you're HIV-positive, and you're devastated. And the nurse takes you into a room, and she tells you about the tests and HIV and the medicines you can take and how to take care of yourself and your baby, and you hear none of it. All you're hearing is, "I'm going to die, and my baby is going to die." And then you're out on the street, and you don't know where to go, And you don't know who you can talk to, because the truth is, HIV is so stigmatizing that, if you partner, your family, anyone in your home, you're likely to be thrown out without any means of support. And this, this is the face and story of HIV in Africa today.
But we're here to talk about possible solutions and some good news. And I want to change the story a little bit. Take the same mother, and the nurse, after she gives her her test, takes her to a room. The door opens, and there's a room full of mothers, mothers with babies, and they're sitting, and they're talking, they're listening. They're drinking tea, they're having sandwiches. And she goes inside, and woman comes up to her and says, "Welcome to mothers2mothers. Have a seat. You're safe here. We're all HIV-positive. You're going to be okay. You're going to live. Your baby is going to be HIV-negative."
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我們將母親視為社群裡最棒的資源,母親們照顧幼小,照顧家園,男人常常不在家,他們出門工作,或不參與家裡的事。我們的組織-媽媽互助天地(mothersmothers)讓那些愛滋媽媽成為照護人員,我們請那些患愛滋病的母親們前來,她們經歷過PMTCT計畫,對此相當熟悉,讓她們回來與醫生護士們一起工作,就像醫療團隊的一份子,我們稱這些母親為輔導媽媽。她們能夠融入這些像她們以前一樣的婦女當中-她們身懷六甲,知道自己得了愛滋病,需要支持與教育。輔導媽媽能在療程中持續地扶持病患,並教導他們如何服藥、如何照顧自己、如何照顧孩子。思考一下:如果你需要開刀,你會希望找最好的外科醫生,對吧?但如果你想瞭解手術對生活造成的影響,你想找的會是歷經過同樣手術的病人。病人是他們所罹患疾病的專家,可以分享自己的經驗給他人,這是除了藥物以外的醫療照護。
這些替我們工作的母親們來自她們工作當地的社區,我們雇用她們,支付與醫療團隊中專業人員相同的薪水,就像醫生及護士一樣;我們替她們開銀行帳戶,薪水直接匯入銀行,保護她們的所得,家中男人無法將她們的薪水取走。她們必須接受二到三週非常嚴格的教育及訓練課程。醫生及護士們也接受過訓練,但通常只有一次而已,所以當有新藥品及新的指導原則發佈時,他們並不知曉。輔導媽媽每年接受訓練及重新培訓,所以醫生及護士們都把她們當成專家看待。想像一下,過去也是病人的婦女竟能教育她的醫生、教育其他她所照顧的病人。
我們的機構有三個目標,第一:預防母子垂直感染。第二:讓母親身體保持健康,讓媽媽們活下去,讓孩子們活下去,不再有孤兒。第三,也是最重要的一點,就是找到賦予女性力量的方法,讓她們能對抗罹患愛滋病的恥辱;雖罹患愛滋病,卻能過著正向、有生產力的人生。我們是怎麼做的?我想也許最重要的就是參與,就是一對一,一對一的面對病人,教育及支持她們,教導她們如何照顧自己。我們所做的不只如此,我們試著找來她們的丈夫、伴侶。在非洲,要男性參與相當困難,男人們通常不參與跟懷孕照護有關的事,但在盧安達這個國家有個政策是,除非有孩子的父親陪伴,否則婦女無法尋求醫療照護,這就是規定。所以父母兩人會一起接受諮詢與檢查,父母兩人一起等待檢查報告,這對打破這個偏見來說相當重要。
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We view mothers as a community's single greatest resource. Mothers take care of the children, take care of the home. So often the men are gone. They're working, or they're not part of the household. Our organization, mothers2mothers, enlists women with HIV as care providers. We bring mothers, who have HIV, who've been through these PMTCT programs in the very facilities, to come back and work side by side with doctors and nurses as part of the health care team. These mothers, we call them mentor mothers, are able to engage women who, just like themselves, pregnant with babies, have found out about being HIV-positive, who need support and education. And they support them around the diagnosis and educate them about how to take their medicines, how to take care of themselves, how to take care of their babies. Consider: if you needed surgery, you would want the best possible technical surgeon, right. But if you wanted to understand what that surgery would do to you life, you'd like to engage someone, someone who's had the procedure. Patients are experts on their own experience, and they can share that experience with others. This is the medical care that goes beyond just medicines.
So the mothers who work for us, they come from the communities in which they work. They're hired. They're paid as professional members of the health care teams, just like doctors and nurses. And we open bank accounts for them, and they're paid directly into the accounts, because their money's protected; the men can't take it away from them. They go through two to three weeks of rigorous curriculum-based education, training. Now, doctors and nurses, they too get trained. But so often, they only get trained once, so they're not aware of new medicines, new guidelines as they come out. Our mentor mothers get trained every single year and retrained. And so doctors and nurses, they look up to them as experts. Imagine that: a woman, a former patient, being able to educate her doctor for the first time and educate the other patients that she's taking care of.
Our organization has three goals. The first, to prevent mother-to-child transmission. The second: keep mothers healthy. Keep mothers alive. Keep the children alive. No more orphans. And the third, and maybe the most grand, is to find ways to empower women, enable them to fight the stigma and to live positive and productive lives with HIV. So how do we do it? Well, maybe the most important engagement is the one-to-one, seeing patients one-to-one, educating them, supporting them, explaining how they can take care of themselves. We go beyond that. We try to bring in the husbands, the partners. In Africa, it's very, very hard to engage men. Men are not frequently part of pregnancy care. But in Rwanda, in one country, they've got a policy that a woman can't come for care unless she brings the father of the baby with her. That's the rule. And so the father and the mother, together, go through the counseling and the testing. The father and the mother, together, they get the results. And this is so important in breaking through the stigma.
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公開病況對預防來說相當重要,如果沒公開,要怎麼進行安全性行為?怎麼普遍地使用保險套?公開病況對治療來說也很重要,因為,同樣的,病人需要家人朋友的支持才能乖乖按時服藥。我們也以團體進行。在團體裡,講課的不是我,而是這些女性們聚在一起,在輔導媽媽的協助及輔導下,她們來到這裡,分享彼此的經驗。透過分享,病患們學會怎麼照顧自己、怎麼對他人坦白、如何服藥。接下來是擴展到整個社區,讓社區內的女性們一同參與。如果我們能改變一個家庭的想法與信念,就能改變整個社群的想法和信念;如果我們能改變大多社群的態度,就能改變整個國家的態度,就能改變整個國家對女性的態度、對愛滋病的態度。最難的障礙是減少對愛滋病的偏見。我們有藥物,也有醫療檢查,但如何減少對愛滋病的偏見?這也與公開病況的重要性有關。
幾年前有位輔導媽媽回來告訴我一個故事。她有個病人,要求她陪她一起回家,因為那位病人想告訴母親及手足自己罹患愛滋病的事,但她不敢一個人面對,所以輔導媽媽陪她一起去。那位病人走進家中,對她母親及手足說,「我要告訴你們一件事,我罹患了愛滋病。」每個人都默不作聲。然後他的大哥站起來說,「我也要告訴你們一件事,我有愛滋病,一直不敢跟你們說。」然後她大姐站起來說,「我也有愛滋病,覺得羞恥而不敢說。」然後她弟弟站起來說,「我也有愛滋病,我怕你們知道後會把我趕出家門。」你們應該猜到後續發展了。最後,妹妹站起來說,「我也有愛滋病,我怕你們會恨我。」就這樣,他們第一次能夠這麼聚在一起,分享這個經驗,給予彼此支持。
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女性旁白:許多女人來到這裡,哭喪著臉,恐懼不已,我分享自己的故事,告訴她們我是愛滋病患者,但我的孩子很健康,我告訴她們,「妳們辦得到的,妳們可以扶養出健康的寶寶。」我就是希望永遠存在的最好證明。
Mitchell Besser:記得我今天給各位看的,那些非洲醫生及護士數量多麼少的資料圖片,這是健康照護系統的危機,就算我們有更多的測試方法與藥品,還是無法擴及到人群,因為沒有足夠的協助者。所以以所謂的任務轉換來說,通常是指讓另一位協助者擔負起原本提供健康照護服務者的工作,一般來說,就是醫生給予護士工作。但非洲的問題是護士比醫生還少,所以我們必須尋找一種新的健康照護範式。如何建立更好的健康照護系統?我們選擇將健康照護系統重新定義為醫生、護士及輔導媽媽,所以護士們能請輔導媽媽們向病人解釋服藥方式及其副作用,她們擔任教導餵食嬰兒、家庭計劃、安全性行為的代表人,執行護士們沒時間做的工作。
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Disclosure is so central to prevention. How do you have safer sex, how do you use a condom regularly if there hasn't been disclosure? Disclosure is so important to treatment, because, again, people need the support of family members and friends to take their medicines regularly. We also work in groups. Now, the groups, it's not like me lecturing, but what happens is women, they come together -- under the support and guidance of our mentor mothers -- they come together, and they share their personal experiences. And it's through the sharing that people get tactics of how to take care of themselves, how to disclose how to take medicines. And then there's the community outreach, engaging women in their communities. If we can change the way households believe and think, we can change the way communities believe and think. And if we can change enough communities, we can change national attitudes. We can change national attitudes to women and national attitudes to HIV. The hardest barrier really is around stigma reduction. We have the medicines, we have the tests. But how do you reduce the stigma? And it's important about disclosure.
So, a couple years ago, one of the mentor mothers came back, and she told me a story. She had been asked by one of the clients to go to the home of the client, because the client wanted to tell the mother and her brothers and sisters about her HIV status, and she was afraid to go by herself. And so the mentor mother went along with. And the patient walked into the house and said to her mother and siblings, "I have something to tell you. I'm HIV-positive." And everybody was quiet. And then her oldest brother stood up and said, "I too have something to tell you. I'm HIV-positive. I've been afraid to tell everybody." And then this older sister stood up and said, "I too am living with the virus, and I've been ashamed." And then her younger brother stood up and said, "I'm also positive. I thought you were going to throw me out of the family." And you see where this is going. The last sister stood up and said, "I'm also positive. I thought you were going to hate me." And there they were, all of them together for the first time being able to share this experience for the first time, and to support each other for the first time.
(Video) Female Narrator: Women come to us, and they are crying and scared. I tell them my story, that I am HIV-positive, but my child is HIV-negative. I tell them, "You are going to make it, and you will raise a healthy baby." I am proof that there is hope.
Mitchell Besser: Remember the images I showed you of how few doctors and nurses there are in Africa. And it is a crisis in health care systems. Even as we have more tests and more drugs, we can't reach people; we don't have enough providers. So we talk in terms of what we call task-shifting. Task-shifting is traditionally when you take health care services from one provider and have another provider do it. Typically, it's a doctor giving a job to a nurse. And the issue in Africa is that there are fewer nurses, really, than doctors, and so we need to find new paradigm for health care. How do you build a better health care system? We've chosen to redefine the health care system as a doctor, a nurse and a mentor mother. And so what nurses do is that they ask the mentor mothers to explain how to take the drugs, the side effects. They delegate education about infant feeding, family planning, safer sex, actions that nurses simple just don't have time for.
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我們回到最初討論的母子垂直感染預防,越來越多人將這類計畫視為母子健康的全面性橋樑,我們的組織幫助女性跨越這座橋樑,醫療照護不是在孩子出生後就終止,我們也照顧母子後續的健康,確保他們都能健康地活下去。
我們組織進行的工作有三個層面,第一、病患層面:照顧母子,避免孩子感染愛滋病,讓母親能健康地撫養小孩。第二、社群層面:賦予女性力量,讓她們成為自己社群的領導者,讓她們改變社群的思考方式。我們必須改變大家對愛滋病的態度,我們必須改變大家對非洲女性的態度,我們必須做到這些。然後重塑健康照護系統層面,建立更強大的健康照護系統。現今的健康照護系統已有缺失,以現有的設計來進行是行不通的,所以那些必須負責改變病人行為的醫生護士們,沒有能力也沒有時間做得完善,但輔導媽媽們有。藉由輔導媽媽的加入,重新組織醫療團隊,我們就能做到這一點。
我們的計畫於2001年從南非開普敦開始,當時這只是個突發奇想的點子,根據Steven Johnson昨天所講述的那篇精彩演講-新點子從哪裡來?我當時沖著澡,獨自一人。(笑聲)這個計畫已在九個國家實行,共有670個據點,每個月能照顧到23萬名婦女。我們僱用了1600個輔導媽媽,去年有30萬名愛滋媽媽參與這個計劃,這佔了全球愛滋媽媽的20%,全世界的20%。這麼簡單的主張,卻有這麼驚人的成果。讓愛滋媽媽照顧愛滋媽媽,讓過去的病患照顧現在的病患,讓就業賦予她們能力,打破固有偏見。
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女性旁白:希望是存在的,我希望有一天我們能贏得這場對抗愛滋病的戰爭。每個人都必須知道自己愛滋病毒的情況,那些未感染愛滋病毒的人要知道怎麼繼續保持,已經感染愛滋病毒的人一定要知道如何照顧自己,感染愛滋病的懷孕婦女一定要加入PMTCT計畫,如此才能生下健康的寶寶。這都是辦得到的,只要每個人都盡一己之力對抗愛滋病。
MB:這個複雜問題的簡單解答,就是讓母親們互相照顧,這可以造成很大的轉變。
謝謝各位
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So we go back to the prevention of mother to child transmission. The world is increasingly seeing these programs as the bridge to comprehensive maternal and child health. And our organization helps women across that bridge. The care doesn't stop when the baby's born. We deal with the ongoing health of the mother and baby, ensuring that they live healthy, successful lives.
Our organization works on three levels. The first, a the patient level -- mothers and babies keeping babies from getting HIV, keeping mothers healthy to raise them. The second, communities -- empowering women. They become leaders within their communities. They change the way communities think. We need to change attitudes to HIV. We need to change attitudes to women in Africa. We have to do that. And then rework the level of the health care systems, building stronger health care systems. Our health care systems are broken. They're not going to work they way they're currently designed. And so doctors and nurses who need to try to change people's behaviors don't have the skills, don't have the time. Our mentor mothers do. And so in redefining the health care teams by bringing the mentor mothers in, we can do that.
I started the program in Capetown, South Africa back in 2001. It was, at that point, just the spark of an idea. Referencing Steven Johnson's very lovely speech yesterday on where ideas come from, I was in the shower at the time. I was alone. (Laughter) The program is now working in nine countries. We have 670 program sites. We're seeing about 230,000 women every month. We're employing 1,600 mentor mothers. And last year, they enrolled 300,000 HIV-positive pregnant women and mothers. That is 20 percent of the global HIV-positive pregnant women, 20 percent of the world. What's extraordinary is how simple the premise is. Mothers with HIV caring for mothers with HIV. Past patients taking care of present patients. And empowerment through employment -- reducing stigma.
(Video) Female Narrator: There is hope, hope that one day we shall win this fight against HIV and AIDS. Each person must know their HIV status. Those who are HIV-negative must know how to stay negative. Those who are HIV-infected must know how to take care of themselves. HIV-positive pregnant women must get PMTCT services in order to have HIV-negative babies. All of this is possible, if we each contribute to this fight.
MB: Simple solutions to complex problems. Mothers caring for mothers. It's transformational.
Thank you.