首發於光明觀察，轉載請註明譯者及出處；本譯文僅供參考，引用請查對原文。
印度將於下周開始投票，選舉出新一屆政府。愛滋病應該成為該政府首先考慮的問題。
在眼下印度的選戰中，愛滋病是一項未被提及的議題。可根據最保守的估計，也已經有60萬印度人成為愛滋病患者，458萬人感染了HIV——引發愛滋病的病毒。這意味著按照愛滋病患者數量來算，印度成為僅次於南非的第二大國。不過，印度僅有0.9%的成年人口HIV檢驗成陽性，南非卻有20%。如果印度的比例僅僅上升幾個百分點，不僅幾百萬的人將不得不與愛滋病一道生活，甚至會死於該病，而且鄰國數以百萬計的人們也在劫難逃。印度的總人口比整個非洲還要多許多。再加上孟加拉、尼泊爾和巴基斯坦，你可以想像出一種影響1/4世界人口的地區性疫症。
幸運的是，沒有那個國家該受天遣，必然在非洲之後被投入愛滋病的地獄。比如巴西和泰國，兩國在10至15年前經歷了HIV的爆發高潮，而災難被逆轉了。怎麼做的？距離不遠的泰國所採取的政策與印度最為息息相關。我們的特別報告評估了印度在多大程度上符合泰國的標準，並且發現該國大多數做法是正確的，儘管緩慢、遲滯、常常在過小的範圍內進行。然而，在兩個特別的方面，印度必須做出更多的努力：印度的抗艾戰需要更多的資金，也需要更強有力的政治承諾。兩者相互關連。
沒有大量開支，哪都不能阻擋愛滋病的流行。泰國預防和治療的花費大約是每人55美分，烏幹達1.85美元，而印度僅17美分。從表面上看，印度的資金問題正在得到緩解。國際機構、世界銀行、雙邊捐贈以及慈善基金都允諾要為此提供大筆款項。但印度自身卻幾乎沒花幾個子兒。這部分反映了該國無可置疑的貧窮，部分體現了政府總體上對國民健康，個別地對愛滋病不夠重視。在2000年（可比較數據存在的最近年份），印度在健康上的花費僅為人均71美元，其中4/5投入了私人部門；其實，一項測算表明政府的健康支出僅為人均4美元。全世界有8個國家的公共醫療預算小於其國民生產總值的1%，印度就是其中之一。
這種對公眾健康的漠不關心還體現在其它統計數據上。印度的肺結核感染者高於任何國家--每天有超過2萬名印度人感染肺結核，每年有45萬人因此喪生。在HIV感染人群中，肺結核是最常見的死因。在性傳播疾病最嚴重國家的排行榜上，印度也名列前茅，而性傳播疾病正是愛滋病傳播的重要因素之一。由世界銀行提供資金的研究表明，在私人部門中，有60%的注射使用了不安全的針頭；在公眾部門這一數字是69%。
難怪一家聯合國機構認為，到2015年印度的愛滋病感染人數會上升到1200萬。印度政府自己已經通過其國家愛滋病控制組織（National AIDS Control Organisation）聲稱，即使它達到了自己的目標，2010年之前仍會有900萬人受到感染。美國中央情報局預計在這一時限之前感染人數會達到2000萬至2500萬。
愛滋病大多是通過性傳播渠道感染的--在印度超過80%的感染始於此徑--而大多數政府發現性是一個難以啟齒的話題。印度也不例外。這片土地可能是《愛經》（Kama Sutra）的誕生地，它的寺廟壁畫上有著其他公共場所鮮見的縱慾場面。但它同時也是一個過分正經的地方，直到最近該國的電影業才開始在銀幕上表現吻戲。相比之下國防就很輕鬆了。在2000年，印度將3.1%的國民生產總值用於國防建設。它擁有核武器，也有一個太空計劃。它甚至向非洲國家提供軟約束貸款，幫助它們對抗愛滋病。但印度卻很不情願啟動一個全面推廣保險套的項目。它轉而傾向於鼓吹ABC--禁慾、忠誠和使用保險套（Abstinence, Be faithful and use a Condom）。據那些對其他流行病有經驗的人士說，這一信息的關鍵部分很可能在傳播中丟失。
許多印度人正在以不同方式盡其所能對抗愛滋病。但如果想要擁有成功的機會，他們就需要上層人物和公共生活中其他行道的人們幫助。首相本人需要親自領導這場戰鬥。他需要讓他手下所有的部長和公務員們在他們所有的講話和和公告中納入關於愛滋病的信息，就像安得拉邦（Andhra Pradesh）的省長已經做的那樣。感染HIV的公眾人物--至少有一名傑出的政治家被普遍認為死於愛滋病--應該站出來並鼓勵他人接受檢驗。板球球星們和寶萊鎢的電影明星們都應該略盡其力。
沒錢不行
愛滋病是一種昂貴的疾病，預防昂貴，治療也昂貴。在有限的預算下，多一分錢投入預防，就意味著少一分投入治療。那麼為什麼，有人會問，有限的資源被用於治療同性戀者、毒品癮君子、妓女和其他性濫交者，這些人都偶然地感染了愛滋病。答案之一在於，如果沒有可以得到治療的保證，沒人會有動力去接受檢驗，而沒有檢驗疾病就將傳播。顯然，愛滋病是一種不容忽視的昂貴疾病。
在印度的許多地區，特別是比較繁榮的地方，愛滋病已經開始影響至今為止還被認為是低危群體的人們，尤其十幾歲的青少年和一夫一妻家庭中的妻子。如果愛滋病橫跨全國在普通百姓中擴散，如同在非洲的某些地區一樣，世界又會增加一個新的令人討厭的疫區。幸運的是印度還具有一些優勢。印度擁有龐大的信息技術產業，它的醫療保健公司和製藥商也有能力進行測試，並在大範圍內——雖然現在還沒有開發——提供廉價藥品。
美國國務卿科林-鮑威爾上周說：「HIV/AIDS （即愛滋病）是今天人類最大的威脅，是地球上最厲害的大規模殺傷性武器。」印度應該聽聽這番話。對於那些一廂情願的思想者、虛假經濟的製造者或是認為愛滋病這一話題難登大雅之堂而不適於公開討論的人們來說，時間並不站在他們那一邊。這種疾病需要來自上層的領導以及公共資金的承諾。印度不能承受其他選擇的代價。
附：原文及網址
http://www.economist.com/opinion/displayStory.cfm?story_id=2603788
When silence is not golden
Apr 15th 2004
From The Economist print edition
Indians start voting next week to choose a new government. Its first priority should be AIDS
ONE subject not being discussed in India's current election campaign is AIDS. Yet, on the most conservative of estimates, 600,000 Indians already have the disease and 4.58m are infected with HIV, the virus that causes it. That means India ranks second only to South Africa in terms of its number of infections-and that with only about 0.9% of the adult population HIV-positive, compared with over 20% in South Africa. If India's rate were to rise by just a few percentage points, not only would millions more Indians be condemned to live with-or, more likely, die of-AIDS, but so would millions of their neighbours. India's population alone is much bigger than the whole of Africa's. Throw in that of Bangladesh, Nepal and Pakistan, and you have the makings of a regional pandemic affecting nearly a quarter of the world.
Fortunately, no country is condemned to follow Africa into an AIDS inferno. As has been shown by Brazil and Thailand, both of which were poised to experience an HIV calamity ten or 15 years ago, disaster can be averted. How? The policies adopted by not-so-distant Thailand probably have the greatest relevance for India. Our special report assesses how India measures up against the Thai standard and finds it is doing most of the right things, albeit slowly, late and often on too small a scale. In two particular respects, though, much more is needed: India's campaign needs more money, and it needs stronger political commitment. The two are related.
Nowhere has an AIDS epidemic been headed off without hefty expenditure. Thailand spends roughly 55 cents per person on prevention and treatment, Uganda $1.85, but India only about 17 cents. On the face of it, India's money problem is being eased. International agencies, the World Bank, bilateral donors and philanthropic foundations have all pitched in with the promise of large sums. India itself, though, has spent next to nothing. In part this reflects the country's undoubted poverty, in part the low priority that the government gives to health in general and AIDS in particular. In 2000 (the latest year for which comparative figures exist), India spent only $71 per person on health, of which four-fifths was in the private sector; indeed, on one measure government health spending was only $4 per person. India was one of only eight countries whose public-health budget took less than 1% of GDP.
This indifference to public health shows up in other statistics. India has more tuberculosis infections than any other country-over 20,000 Indians catch TB each day and almost 450,000 of them die of it each year. TB is the commonest cause of death among HIV-positive people. India is also high in the league table for sexually transmitted disease, a crucial factor in the spread of HIV. And, according to a study paid for by the World Bank, 60% of injections in the private sector are carried out with unsafe needles; in the public sector the figure is 69%.
No wonder one UN agency thinks the number of Indian infections will rise to 12m by 2015. The government itself, in the shape of its National AIDS Control Organisation, has said that even if it achieves its own objectives 9m Indians will be infected by 2010. America's CIA predicts 20m-25m by that date.
AIDS is mostly spread by sex-in India over 80% of infections start this way-and most governments find sex an awkward subject. India's is no exception. It may be the land of the Kama Sutra, the land whose temples depict a licentiousness seldom shown in public elsewhere. But it is also a land so prudish that its film industry has only recently started to show kisses on screen. Defence is easy by comparison. India spent 3.1% of GDP on defence in 2000. It has nuclear weapons. It also has a space programme. It even offers soft loans to African countries to help them fight AIDS. But it is loth to launch an all-out programme to promote condoms. It prefers instead to preach ABC-Abstinence, Be faithful and use a Condom-a message whose crucial component tends to get lost in transmission, say those with experience of other epidemics.
In different ways, many Indians are doing their best to battle AIDS. But if they are to have a chance of success, they need help from the people at the top, and from others in every other walk of public life. The prime minister himself needs to take charge of the campaign. He needs to make all his ministers and civil servants include a message about AIDS in all their speeches and pronouncements, as the chief minister of Andhra Pradesh already does. Public figures infected with HIV-at least one prominent politician is widely believed to have died of AIDS-must stand up and encourage others to take tests. Cricketers and Bollywood stars must do their bit.
No cheap way out
AIDS is an expensive disease, expensive to prevent and expensive to treat. With a limited budget, more money for prevention means less for treatment-and why, ask some, should scarce resources go to treating homosexuals, drug addicts, prostitutes and other promiscuous people who happen to have contracted AIDS? One answer is that without the promise of treatment no one has the incentive to be tested, and without tests the disease will spread. Then it will be apparent that AIDS is also an expensive disease to neglect.
In much of the country, particularly the more prosperous parts, it already affects other groups hitherto considered low-risk, notably teenagers and monogamous wives. Were it to spread into the general population right across the country, as it has in parts of Africa, the world would have a new pandemic of hideous proportions. Fortunately, India has some advantages. It has a vast information-technology industry and its health-management companies and drug makers are capable of carrying out tests and providing cheap drugs on a huge-and as yet unexploited-scale.
America's secretary of state, Colin Powell, said last week that "HIV/AIDS is the greatest threat of mankind today, the greatest weapon of mass destruction on the earth". India should listen. Time is not on the side of the wishful-thinkers, the makers of false economies or those who think AIDS is too unsavoury a subject for widespread public discussion. This disease demands a lead from the top, and a commitment of public money too. India cannot afford the alternative.
文章來源：譯者賜稿