艾滋病

　　A spectre returns

　　幽灵般的转机

　　The fall in HIV infections conceals a worrying rise among gay men

　　艾滋病感染率下降安抚了日益惶恐的男同性恋们

　　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世纪80年代有一个这样的电视画面：火山喷发，乌云密布，天空下一座黑色的墓碑上刻着“AIDS”（艾滋病）字样。一个冰冷的声音反复出现“不要死于无知”。人们对艾滋病的惶恐情绪迅速蔓延。而今改善的医疗技术以及对艾滋病毒传播途径更为详细的理解都使艾滋病不再是死刑的代名词。但是伴随着好消息而来的也有些令人担忧的情况：伦敦男同性恋者中艾滋病感染率上升。

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　　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日英国全民医疗服务下属的英格兰公共卫生部门（PHE）公布的数据表明，2013年伦敦艾滋病毒携带者有110,000人，创下历史新高。但是也有值得庆祝的事情：这些艾滋病毒携带者的寿命将延长。人们接受检测的频率增多，也能更快得到治疗。2004年到2013年异性恋者之间的艾滋病感染新增人数减少了一半。

　　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，男同性恋者中的艾滋病感染新增人数增至3250，增加了三分之一。伦敦13%的男同性恋者携带有艾滋病毒。相比之下的旧金山，患病人数就略高一些—大约保持在24%左右—但新诊断的人数所占比率在下降，而在伦敦，这个数量却有所上升。很大程度上得益于更精准的病情监测。但是轻率地行径同样是病患人数上升的一大祸源。

　　“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.

　　“化学性爱”——在性爱前或性爱后服用毒品，尤其是冰毒， 伽玛丁内酯（GBL）或是甲氧麻黄酮——是主要的诱因。此类药物刺激性欲，延长人们性爱时间，与大量的同伴性爱更易造成外伤和擦伤，二者都增加了艾滋病传播的几率。网络让人们更容易接触到随意的性爱伙伴。迪恩街56号英国全民医疗服务性爱健康诊疗中心的大卫·斯图尔特说，该中心每月大概会接待100位借助药物进行性爱的男同性恋。大多数在最近的六个月内都是服药性爱。

　　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.

　　文化观念的转变也是一个原因。斯图尔特表示，对一些人来说，借着毒品和逃避现实，对HIV的恐慌更可能使它变为一个逃避话题。。但是杂志编辑兼戏剧演员Amrou al-Kadhi担心其他人不肯接受现实。由于当前医疗技术进步不小，有人会认为无需担忧。他担心有些人将做爱后预防药看的跟避孕药似的，尽管此类药物可能会预防直接暴露于艾滋病后的感染。他建议，经历过艾滋病蔓延的年长男同性恋者和比较自满的年轻人需要分别对待。

　　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.

　　英格兰公共卫生部门（PHE）的研究员科林·布朗表明测试并不如大家所料的那样普遍。2011年，英国51%的男同性恋表明在过去的一年里做过艾滋病体检。但伦敦性爱健康诊所的数据表明只有20%甚至更低的艾滋病阴性的男同性恋者每年接受艾滋病测试，仅占旧金山的一半。较于伦敦，旧金山感染人数的比例—这些感染人群更易传染他人—已经骤降，但旧金山却并未意识到。

　　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.

　　较高的医疗水平让艾滋病活动者进退两难。他们既想降低艾滋病的感染率，又想宣传降低感染风险的行为。但是他们也想确保那些已感染了艾滋病毒的人们活的更久些。有一部分同性恋因为关注了那些宣传行为而感染了艾滋病。