HAVANA – Cuba has one of the world’s smallest AIDS epidemics. Its harsh early tactics – until 1993, everyone who tested positive for H.I.V. was forced into quarantine – has succeeded: the country now has a mere 14,038 cases. Its infection rate is 0.1 percent, on par with Finland, Singapore and Kazakhstan. That is one-sixth the rate of the United States, one-twentieth of nearby Haiti.
古巴是愛滋病流行情況最輕微的國家之一。古巴政府很早就採取嚴格的防制措施，例如，在1993年之前，任何古巴人經檢驗呈愛滋病毒陽性反應，一律強制隔離。這項政策非常成功：古巴全國目前只有14,038個愛滋病例，感染率0.1%，與芬蘭、新加坡、哈薩克相當，而且只有美國的六分之一，更僅及鄰國海地的二十分之一。

The population of Cuba is only slightly larger than that of New York City. In the three decades of the global AIDS epidemic, 78,763 New Yorkers have died of AIDS. Only 2,364 Cubans have.
古巴總人口僅略多於紐約市。在愛滋病肆虐全球的30年之間，紐約死於這種疾病的人合計78,763人，古巴則只有2,364人。

Other elements have contributed to Cuba’s success: It has free universal basic health care; it has stunningly high rates of H.I.V. testing; it saturates its population with free condoms, concentrating on high-risk groups like prostitutes; it gives its teenagers graphic safe-sex education; and it rigorously traces the sexual contacts of each person who tests positive.
古巴防制愛滋成功，還有些其他因素。它有免費的全民基本醫療保健；愛滋檢驗的百分比高得驚人；大量發放免費的保險套，主要鎖定妓女之類的高危險群；對青少年男女施以附有生動圖說的安全性教育，同時密切追蹤呈病毒陽性反應者的性接觸行為。

Cuba has succeeded even though it has the most genetically diverse epidemic outside Africa, with 21 different strains. And its success has come despite the country being a sex tourism destination for Europeans and Canadians.
雖然境內的病毒種類多達21種，在非洲以外地區居冠，古巴防制愛滋還是相當成功。同時，歐洲人與加拿大人愛來買春，也沒有影響防制上的成效。

While the police enforce laws against streetwalking, bars and hotel lobbies in Havana are filled with young women known as jineteras – slang for “jockeys” – who approach foreigners with the unspoken assumption that the meeting will lead to sex. Even so, of the roughly 1,000 new infections diagnosed each year, 81 percent are among men and very few among young unmarried women.
雖然古巴警方依法取締賣淫，首都哈瓦那的酒吧與飯店大廳仍然不時可見俗稱「騎師」的年輕女子主動接近外國人；雙方心照不宣，就是要做性交易。即使如此，在每年確診的約1000個新增愛滋病例當中，大約81%是男性，年輕未婚女性非常少。

In a survey in 2009, 77 percent of all sex workers said they regularly used condoms.
2009年的調查統計顯示，77%的古巴性工作者表示，她們固定使用保險套。

There are male jineteras for gay tourists too, of course, “but we believe the main vector is within the people,” said Dr. Luis Estruch Rancaño, deputy minister for public health. “Mainly, the very promiscuous group in the homosexual community who have many partners and don’t take precautions.”
古巴公共衛生部副部長藍卡紐指出，古巴當然也有專門向同志觀光客賣淫的男妓。他說：「不過我們認為，最主要的傳染媒介還是那一群人，最主要還是性伴侶眾多且不採取任何防範措施的雜交嚴重同志族群。」

The few Cuban women who are infected usually get the virus from partners who are secretly bisexual, experts said.
專家說，少數受到感染的古巴婦女通常因為伴侶是秘密的雙性戀者而受害。

Heroin use, which drives epidemics in many countries, is virtually nonexistent in Cuba, officials insist.
在許多國家吸食海洛因助長了愛滋的傳染。古巴官員斬釘截鐵的說，古巴幾乎沒人吸食海洛因。

And since 1986, only 38 babies have been born with the virus. In Cuba, pregnant women are tested for H.I.V. at least twice, and H.I.V.-infected women get antiretroviral drugs free.
1986至今，只有38個古巴嬰兒出生時即已感染病毒。古巴孕婦至少須接受2次病毒檢驗，受感染婦女可免費獲得抗逆轉錄病毒藥物。

Dr. Jorge Pérez Avila is Cuba’s best-known AIDS doctor. In his book, “AIDS: Confessions to a Doctor,” he says it was Fidel Castro who, in 1983, galvanized Cuba’s response to AIDS.
貝雷茲是古巴全國最知名的愛滋病醫師。他在所著「愛滋病：向一名醫師的告白」一書中指出，1983年，古巴前總統卡斯楚發起了古巴全國抗愛滋行動。

The medical establishment reacted quickly. Doctors were sent to Brazil and France to study cases. In 1986, blocked by the American embargo, Cuba bought 750,000 French test kits.
古巴醫學界迅速響應。大批醫師奉派前往巴西與法國研究病例。1986年，在美國實施禁運下，古巴向法國購買75萬套檢驗工具。

Now, all family doctors watch for infections that indicate AIDS, like Kaposi’s sarcoma or Pneumocystis carinii pneumonia. Everyone who tests positive for AIDS must take a two-week course in “living responsibly with H.I.V.”
如今，所有的古巴家醫科醫師隨時密切注意各種足以顯示愛滋的感染症狀，例如卡波希肉瘤或間質性漿細胞肺炎。任何人只要愛滋病毒檢驗呈陽性反應，一律須接受2個星期的「愛滋患者負責任的生活方式」的課程。

With mandatory quarantine long gone and the virus now mostly in gay and bisexual men, new infections are slowly but steadily rising. They now approach 1,000 a year, “and we’re waiting for the plateau,” said Dr. José Joanes Fiol, the Health Ministry’s chief epidemiologist.
強制隔離已廢除，如今感染者多為同性戀與雙性戀男子，新的感染病例已經開始慢慢增加。古巴衛生部的首席流行病學專家侯亞尼斯指出，目前每年接近1000例，「我們正在等待高峰出現」。

The government distributes more than 100 million condoms a year. Every place with young customers, even pizzerias, is required to stock them.
古巴政府每年分發保險套超過1億個，同時規定每一個有年輕顧客上門的地方都必須貯備，連披薩店也不例外。

“The first ones we got were from China, and had butterflies and penguins on the package,” Manuel Hernández Fernández, an AIDS educator, said.
愛滋病教育工作者艾爾南德茲說：「我們進口的第一批保險套來自中國大陸，包裝上印有蝴蝶與企鵝的圖案。」

Cuban society is the opposite of puritanical; scanty clothing is routine, flirtation is common, and so are divorce and affairs.
古巴社會與清教徒社會大大相反。衣著清涼司空見慣；調情很普遍。離婚與婚外情亦然。

Today there is more acceptance of homosexuality. At the same time, the government controls virtually all real estate, and there are no gay bars or hotels. Cruising men often have unsafe sex in abandoned buildings or parks, said Libán Molina, 41, a volunteer at an AIDS prevention hot line.
如今的古巴社會更能容忍同性戀。同時，古巴政府仍然控制全國的房地產，因而沒有同志酒吧或飯店。41歲的愛滋防制熱線志工莫里納表示，在街上結識的男子通常只能在廢棄的大樓或公園從事不安全的性行為。

Only about half of the 11,674 Cubans living with H.I.V. are now on antiretroviral drugs.
感染愛滋的11,674個古巴人，約僅半數在使用抗逆轉錄病毒藥物。

In theory, Cuba would be an ideal laboratory for “test and treat,” the new protocol in which patients who test positive go on drugs immediately to reduce by 95 percent their chance of infecting anyone else.
理論上，古巴是「檢驗、治療」的理想實驗室。根據這項新草案，病毒檢驗呈陽性反應的人必須立刻接受藥物治療，俾將感染他人的機率減少95%。

However, it requires modern drugs and Cuba makes only the older, harsher ones.
然而這麼做必須有現代藥物。古巴目前只能生產比較舊型，而且比較粗糙的藥物。然而這麼做必須有現代藥物。古巴目前只能生產比較舊型，而且比較粗糙的藥物。

Yudelsy García O’Connor, the first baby known to have been born with H.I.V. in Cuba, was near death in her youth. Today she is vibrant and funny. Her father died of AIDS when she was 10, her mother when she was 23.
尤蒂爾絲‧賈西亞‧歐康納是已知一出生就感染愛滋病毒的第一個古巴人，幼時幾乎性命不保。如今的她不但充滿活力，而且非常風趣。她的父母分別在她10歲及23歲時死於愛滋病。

“I’m not afraid of death,” she said. “It comes for everyone. But I take my medicine.”
她說：「我不怕死。人人都會死。不過我按時服藥。」

原文參照：
http://www.nytimes.com/2012/05/08/health/a-regimes-tight-grip-lessons-from-cuba-in-aids-control.html

2012-05-29聯合報/G5版/UNITEDDAILYNEWS 陳世欽譯 原文參見紐時週報十版右