The global fight against HIV/AIDS, in chaos
发布时间 2025-04-07 20:09:40 来源
So we're sitting here and Mary, you've just taken your kids to school. You've been trying to get them to school, but they keep coming back. What is the issue? The issues that I don't have the school fees, the money they want. This is Mary. She's a former sex worker in Kenya. She's speaking with the post-Nyrobe correspondent Catherine Horold. They're talking about her current financial situation and why she doesn't have enough money to pay school fees for her kids. I don't have a job right now, so I have to struggle here and they have to find the school fees, but the issue here is money.
所以我们现在坐在这里，玛丽，你刚刚送孩子们上学。你一直在努力让他们上学，但他们总是又回来。问题出在哪里呢？问题是我没有学费，也就是他们要的那些钱。这位是玛丽，她是肯尼亚的一名前性工作者。她正在与邮报驻内罗毕记者凯瑟琳·霍罗德交谈。他们在讨论她目前的经济状况，以及为什么她没有足够的钱来支付孩子们的学费。我现在没有工作，所以我必须在这里努力，他们也需要找到学费，但问题就在于钱。
She lives in the capital, Nairobi, and Catherine says that until recently, Mary had been working an HIV outreach in her community. She's one of the people that has been trying to change things for the better. She has been trying to educate her community about the dangers and about the treatment, how to protect yourselves, what to do, how to live positively. That's which calls it. Mary's work received funding from USAID, the US Agency for International Development, which delivers billions of dollars of lifesaving food, water, and medical aid to people around the world.
她住在首都内罗毕，凯瑟琳说，直到最近，玛丽一直在她的社区从事艾滋病宣传工作。她是那些努力改善现状的人之一。她一直在尝试教育她的社区，告诉他们关于这种疾病的危险性和治疗方法、如何保护自己、应该怎么做以及如何积极生活。这就是她所做的工作。玛丽的工作得到了美国国际开发署（USAID）的资助，这个机构为世界各地的人们提供了数十亿美元的救命食品、水和医疗援助。
You know, she was just scraping my, she got about $100 a month stipend from this program that she worked for doing HIV education outreach. You know, they were hanging on by their fingernails, but they were hanging on. But then everything changed when President Trump took office in January. Just suddenly, there was nothing there. They were just tumbling through thin air. On his first day in office, Trump signed an executive order, pausing nearly all foreign aid. And pretty immediately, the money Mary and her family relied on stopped coming. On top of that, there were also disruptions to an HIV AIDS program that Mary and millions of others have relied on, called PEPFAR, which stands for the President's Emergency Plan for AIDS Relief.
你知道，她当时仅靠从一个她为其工作的项目中得到的每月约100美元的补助金来维持生活，该项目是关于HIV教育宣传的。虽然很艰难，但他们勉强撑住了。然而，当特朗普总统在一月份上任后，一切都变了。突然之间，一切援助都消失了，他们就像在空中翻滚。特朗普上任当天就签署了一项行政命令，中止了几乎所有的对外援助。很快，玛丽和她家人依赖的钱就停止了。除此之外，玛丽和数百万人依赖的一个名为PEPFAR的抗击艾滋病项目也受到影响，PEPFAR是“总统艾滋病紧急救援计划”的缩写。
This is globally recognized as one of the most successful health programs in the history of the world. And you know, it's been winning. And now we're definitely going to see some more victories by the disease. Because that has already happened because of some of these interruptions. It is a distant is. From the newsroom of the Washington Post, this is Post Reports. I'm Colby Ekoitz. It's Monday, April 7. Today, the legacy of the U.S. led fight against HIV AIDS. It's uncertain future under the Trump administration and the life and death consequences for people like Mary.
这被全球公认为世界历史上最成功的健康项目之一。你知道，它一直在取得胜利。然而，由于一些中断，我们现在肯定会看到疾病的更多胜利。这已经在某些地方发生了。这是来源于《华盛顿邮报》新闻编辑室的报道，我是科尔比·埃克沃茨。今天是4月7日，星期一。我们将探讨美国主导的抗击艾滋病斗争的遗产、其在特朗普政府下的不确定未来，以及对像玛丽这样的人的生死影响。
And just a warning, this episode includes references to sexual violence and assault. So please take care while listening. Katherine, hello. Hi there. You've been spending time with a woman named Mary and Kenya. And I should say that we're only using Mary's first name to protect the identity of her kids and their HIV status. And we just heard a little bit about what she's going through. Can you tell me more about her and why we're hearing from her? What is her backstory?
请注意，本集节目包含与性暴力和袭击相关的内容。在收听时请留意自己的感受。凯瑟琳，你好。嗨，你好。你最近和一位名叫玛丽的肯尼亚女性在一起。我需要说明的是，我们只用玛丽的名字来保护她孩子的身份和他们的艾滋病状况。我们刚刚听了一些关于她的情况。你能告诉我更多关于她的故事以及我们为什么要听她的故事吗？她的背景是什么？
So Mary is a hustler. And Mary is somebody who loves kids. I have eight kids. For them, I'm not mine. They're not my biological. I adapted them from their mother when she passed away. And Mary is somebody who cares about her community. I am an activist. Also, I advocate for the rights of sex, or because they're young women and women. I fight for their rights. So, me and community were very connected. And she's a woman who has managed to build a life for herself and her family, despite all these knocks that life has given her.
所以，玛丽是一个非常勤奋努力的人。玛丽也非常爱孩子。我自己有八个孩子，但他们并不是我的亲生儿女，是在他们的母亲去世后，我收养了他们。玛丽也非常关心她的社区。我是一名活跃分子，并且为年轻女性和女性的权益发声。我为她们的权益而努力奋斗。所以，我和我的社区之间有着非常紧密的联系。玛丽是一个尽管经历了生活中的各种波折，仍然为自己和家人成功创造出生活的女性。
My mom used to be a sex worker. Her mother was a sex worker who was murdered when Mary was two years old. She was raped when she was 13 and had her first child. She went on to have several more children. And then, when a colleague of hers, a friend of hers was murdered by a client, she ended up taking home those four children from the woman's funeral because nobody else wanted them. So, she's always trying to help people.
我妈妈以前是一名性工作者。她的母亲也是性工作者，在我妈妈两岁时被谋杀。妈妈13岁时遭到强奸，并生下了她的第一个孩子。后来，她又生了几个孩子。当时，一个同事兼朋友被客户杀害了，在那个女人的葬礼上，由于没有其他人愿意照顾她的四个孩子，我妈妈把他们带回了家。所以，我妈妈一直都在努力帮助别人。
I have a lot of issues going on at Taco Bell. She lives in a two-room apartment with all these children, except for one who's a boarding school. It's pretty cramped, but you know, you can see how much care she takes there. She set up a reading corner for them. She has a sign on the bathroom door, you know, certainly exhorting everybody to keep clean. She's got a pile of school shoes in the corner for them. And the thing I love the most is she's got a little poem from her kid's tape top next to her mirror with a rose, a plastic rose.
我在塔可钟遇到了很多问题。她和所有这些孩子住在一个两居室的公寓里，除了一个在寄宿学校。虽然地方很挤，但你能看到她很用心地照顾那里。她给他们设置了一个阅读角。浴室门上有一个标牌，提醒大家保持清洁。角落里放了一堆学鞋。我最喜欢的一点是，她在镜子旁贴了孩子写的小诗，还有一朵塑料玫瑰。
And I really like that. What does the poem say? It says, thank you for your parenting and we believe in you and we love you. Oh. So, Katherine, you and Mary, you both live in Kenya and I want to try to understand the region a bit better. What is the situation like there? And what stands out to you about Mary's neighborhood in particular?
我非常喜欢这一点。诗中是怎么说的呢？它说，感谢您的养育之恩，我们信任您并爱着您。哦。那么，Katherine，你和Mary都住在肯尼亚，我想更好地了解这个地区。那里的情况如何？Mary所住的社区有什么特别之处吗？
So, Kenya is the most stable and prosperous country in East Africa and is also America's closest ally in Africa. Kenya is a country of a lot of contrasts. There's obviously these extremely high-end luxury lodges where people come to look at rare animals and go on safari. But there's also neighborhoods in Nairobi, like the one that Mary lives in, where there's no paved roads just outside her house.
肯尼亚是东非最稳定和繁荣的国家，也是美国在非洲最亲密的盟友。这个国家充满了各种对比。一方面，有非常高档的奢华旅馆，游客可以在那里观赏稀有动物和进行狩猎旅行。另一方面，在内罗毕的一些社区，比如玛丽所住的地方，她家外面甚至没有铺好的道路。
The kids have to pick over puddles of sewage to get to school. It's very dangerous at night, you know, when her gas ran out recently when she was trying to cook her kids a meal and she had to venture out into the night with her pot to try and cook it on a neighbor's stove. It's really dangerous because there's gangs that hang around out there and there's not a lot of economic opportunities.
孩子们不得不绕过污水坑去上学。这在晚上非常危险。你知道吗，有一次她正在给孩子们做饭，煤气正好用完了，她不得不带着锅在晚上外出，试图在邻居的炉子上做饭。这很危险，因为外面有团伙活动，而且经济机会也不多。
So a lot of the women and some of the men do resort to sex work just to pay the bills to feed their children. A lot of the people doing the sex work are actually mothers trying to feed their children. So it's very common. And we heard Mary describe herself earlier as an activist and an advocate for sex workers and for women.
很多女性和一些男性为了支付账单和养活孩子，不得不从事性工作。实际上，从事性工作的大多数人都是母亲，她们努力养活自己的孩子。所以这种情况很常见。同时，我们听到玛丽之前自我介绍为性工作者和女性权益的活动家和倡导者。
What exactly does she do to support them in the community? She set up an organization called The Night Nurses and when she first saw me writing that down, she said very firmly, that's night with a K because she's a fighter. I do empower female sex workers to negotiate and to get justice. Basically, she's the person that the sex workers call when they have a problem.
她具体是怎么在社区里支持她们的呢？她创立了一个叫做“夜护士”组织。当我第一次把这个名字写下来的时候，她非常坚定地告诉我，“夜”是以“K”开头的（Knight），因为她是个斗士。她的工作是赋予女性性工作者谈判和争取正义的权力。基本上，性工作者遇到问题时就会找她帮忙。
If they've been arrested, if they're being held hostage by a client, which happens quite often, if they're being robbed or threatened. And some of them are sometimes being arrested illegally, also if they do follow up. The police call her when they find a body because they get murdered quite often. So everybody knows Mary. And several times while I've been with her, people have phoned her just asking for money to feed their kids or somebody needed a policeman bribe, after they got arrested, women needing health care for an emergency situation.
如果他们被逮捕了，被客户劫持了——这些情况经常发生——或者他们遭遇抢劫或威胁。有时候，他们甚至会被非法逮捕。如果他们有后续事宜要处理，也是这样。警察在发现尸体时会打电话给她，因为这些人经常被谋杀。所以大家都知道玛丽。在我和她一起的时候，好几次有人打电话给她，只是为了要钱来喂养他们的孩子，或者有人因为被逮捕后需要贿赂警察，女性需要紧急医疗服务。
You know, her phone never stops ringing. And I know she also does a lot of work in HIV prevention and care. I imagine HIV is pretty prevalent there where she is. Yes. So a lot of the sex workers have HIV and some of their older children do as well. In recent years, most of the HIV positive mothers have managed to get medication that stops them from passing it on to their younger children.
你知道吗，她的电话一直在响。我知道她在艾滋病预防和护理方面做了很多工作。我想艾滋病在她那个地方可能很普遍。是的，很多性工作者都感染了艾滋病，他们的一些年长孩子也是如此。不过，近年来，大多数艾滋病阳性的母亲都能获得药物，阻止她们把病毒传给年幼的孩子。
One of the children that Mary cares for has HIV. But Mary's been very effective at getting her medicated and supported with food. Yeah. Tell me a little bit about the medications that exist now for HIV that kind of helps keep HIV at bay and that are these life-saving treatments.
玛丽照顾的一个孩子感染了HIV。但玛丽在为她提供药物治疗和食物支持方面非常有效。是的。能不能简单介绍一下目前有哪些HIV药物可以帮助控制病毒发展，并拯救生命呢？
So HIV stands for the human immunodeficiency virus. And that's a virus that attacks the body's immune system. And HIV, if left untreated, eventually develops into acquired immunodeficiency syndrome. And that's the most advanced stage. It makes a person much more vulnerable to infection. So really simple diseases. Even the common cold can kill you off.
HIV代表人类免疫缺陷病毒。这是一种攻击人体免疫系统的病毒。如果不加以治疗，HIV最终会发展成获得性免疫缺陷综合症（艾滋病），这是疾病的最严重阶段。此时，人体会变得对感染更加脆弱。即使是很普通的疾病，像感冒，也可能危及生命。
For the first line of medication, the anti-retrovirals, which are usually called ARVs. Those cost about 15 cents a day. And they're very cheap, very widespread. And they can suppress the viral loads so effectively that people don't pass the virus on anymore. And is it the type of medication that you have to take every day at the same time?
对于一线药物，即抗逆转录病毒药物，通常称为ARVs。这些药物每天的费用大约是15美分，非常便宜且广泛使用。它们可以有效地抑制病毒载量，以至于感染者不再传播病毒。这种药物需要每天在同一时间服用吗？
It's like very important that you stay on a schedule. It is super important that you stay on a schedule. Because otherwise the medication can cease to be effective. You might have to go onto a different drug regime, which is much more expensive. Or the virus can come back very quickly. So any break in this drug regimen is of great concern to people.
保持按时服药是非常重要的。否则，药物可能会失去效果，你可能需要更换药物，这会更昂贵。而且，病毒可能会很快复发。所以，任何中断药物治疗的情况都是非常令人担忧的。
HIV is transmitted through things like sex. It can be through mother to child when you're giving birth. But one of the great successes is that these drugs prevent mother to child's transmission. And so that means if you're pregnant and you know your HIV positive, they can give you drugs so that your baby can be born healthy.
HIV 可以通过性行为传播，也可以在母亲分娩时从母亲传给孩子。但一个巨大的成就就是有些药物可以阻止HIV从母亲传给孩子。这意味着，如果你怀孕了并且知道自己HIV阳性，医生可以给你药物，这样你的宝宝就可以健康出生。
So there's been lots of pretty effective efforts to prevent and treat HIV AIDS in Sub-Saharan Africa by marrying many, many others. And a lot of that has been through this program we mentioned earlier called PEPFAR. How did that get started? I mean around the year 2000s, you had a generation of people that were dying and so many more were infected.
所以，通过结合许多其他措施，撒哈拉以南非洲地区在预防和治疗HIV艾滋病方面取得了许多相当有效的努力。其中很大一部分是通过我们之前提到的一个名为PEPFAR的项目实现的。那么这个项目是如何开始的呢？大约在2000年左右，有一代人正在死去，还有更多的人被感染。
But when PEPFAR was created, you know, this immediately started driving down deaths. The US launched PEPFAR in 2003. It was the president's emergency plan for AIDS relief. And that was the single largest public health initiative by any nation in the world aimed at a disease. Seldom has history offered a greater opportunity to do so much for so many. It was a bipartisan program that was introduced by George W. Bush. This comprehensive plan will prevent seven million new AIDS infections, treat at least two million people with life-extending drugs, and provide main care for millions of people suffering from AIDS and for children orphaned by AIDS. And he really drove it forward and he called it a work of mercy. And that's really what it has been. It's saved people from becoming orphans. It's saved people from dying. It's saved people from becoming infected because there was more testing and then there's more drugs available.
但是，当PEPFAR成立时，这项计划立刻开始减少死亡人数。美国于2003年启动了PEPFAR，这个计划是时任总统的艾滋病紧急救援计划。它是世界上任何国家针对某一疾病发起的规模最大的一次公共卫生行动。历史上很少有如此重大的机会能为如此多的人做出如此大的贡献。这个由乔治·W·布什引入的计划是两党合作的结果。这项全面的计划旨在预防七百万个新的艾滋病感染，向至少两百万人提供能够延长生命的药物治疗，并为数以百万计的艾滋病患者及因艾滋病而失去父母的儿童提供主要护理服务。布什积极推动这项计划，并称之为一项仁慈之举。而这的确就是它的意义所在。这个计划拯救了许多人，使他们不再成为孤儿；它拯救了许多人的生命；由于更多的检测和药物供应，它还防止了更多人被感染。
To the point where now, you know, the number of deaths, those numbers have dropped dramatically. And in Kenya, we had I think more than 150,000 people dying of AIDS the year that PEPFAR was founded. And then by 2023, that had dropped down to 20,000 deaths. So you've seen this program have an enormous impact. And one of the most amazing things is that the increases in testing and treatment were driving down death and infection rates so low to the point where HIV could be eliminated as a public health threat from most of the world by 2030. So yes, there would still be people dying. There would still be people being infected. But really, they were getting towards, you know, they were aiming towards 95% of people detected and 95% of people on treatment. And when you reach that point, you really got the disease under control.
到目前为止，死亡人数已经大幅下降。以肯尼亚为例，在PEPFAR（总统艾滋病紧急救援计划）成立的那一年，大约有超过150,000人死于艾滋病。而到2023年，这个数字已经降到20,000人。因此，可以看到该计划产生了巨大的影响。其中一个最令人惊讶的成果是，通过增加检测和治疗，死亡率和感染率大幅降低，以至于到2030年，艾滋病可以在大部分地区不再构成公共卫生威胁。当然，依然会有人因为艾滋病去世，也会有人被感染，但他们的目标是实现95%的人被检测出以及95%的人接受治疗。当达到这个阶段时，艾滋病就真的得到控制了。
After the break, how major disruptions to PEPFAR and other US support are already affecting the global fight against HIV? We'll be right back. I'm Robin Kavan and I'm the senior critic at large for the Washington Post. I write about politics and race and the arts. You know, there's so much information and misinformation coming at people. And for me, a critic's job is to really cut through that and attempt to direct people towards what is of value. Subscribers are definitely the most engaged and there are the ones that I feel like I'm most often having a conversation with. People who are really engaged in our culture and engaged in civic life in a way that can be really transformative. When you subscribe to the Washington Post, you support this kind of journalism. Learn more at subscribe.washingtonpost.com.
休息过后，我们将讨论PEPFAR（总统防治艾滋病紧急救援计划）和其他美国支持的重大中断如何已经影响到全球抗击艾滋病的努力？我们马上回来。我是Robin Kavan，《华盛顿邮报》的特约高级评论员。我撰写有关政治、种族和艺术的文章。如今信息和误导信息纷至沓来，而评论家的工作就是要拨云见日，引导人们关注真正有价值的东西。订阅者是最投入的群体，我觉得自己常常是在与他们对话。他们对我们的文化和公民生活非常关注，并以一种可能带来巨大变革的方式参与其中。当您订阅《华盛顿邮报》时，您就是在支持这样的新闻报道。了解更多内容，请访问 subscribe.washingtonpost.com。
I'm Robin Kavan and I'm one of the people behind the post. That executive order put a 90-day freeze on nearly all global aid, including PEPFAR. And President Trump said that the reason for that freeze was they wanted to make sure that American taxpayers' money was being spent properly. And there were a lot of allegations that were made that were never really substantiated or turned out to be completely false. Like this allegation that the USAID spent $50 million on condoms in Gaza. We identified and stopped $50 million being sent to Gaza to buy condoms for Hamas, $50 million. And you know what's happened to them? They've used them as a method of making bombs.
我是罗宾·凯文，我是这篇文章背后之一。该行政命令对几乎所有的全球援助，包括“总统艾滋病紧急救援计划”（PEPFAR），进行了为期90天的冻结。特朗普总统表示，冻结的原因是他们想确保美国纳税人的钱被正确使用。然后有很多指控从未得到证实或者被证明是完全错误的。比如有一种指控说，美国国际开发署在加沙花费了5000万美元来购买避孕套。我们发现并阻止了5000万美元被送往加沙购买哈马斯的避孕套。你知道他们怎么用这些钱的吗？他们把它们用作制作炸弹的方法。
Which was completely untrue but was repeated by members of the administration for weeks after it was thoroughly debunked. Yeah, I remember that. And then there was that moment where Elon Musk, the head of the Department of Government Efficiency, which we all know as Doge, was asked about this because he had promoted that exact false claim on X. Well, first of all, some of the things that I say will be incorrect and should be corrected. So nobody's going to buy a thousand. I mean, any, you know, we will make mistakes, but we'll act quickly to correct any mistakes. So, you know, if the, I'm not sure we should be sending $50 million dollars to anywhere, frankly.
这完全是不真实的，但在谣言被彻底揭穿后，政府中的一些成员仍然重复了几周。是的，我记得那件事。然后还有一个时刻，埃隆·马斯克，被称为Doge的政府效率部的负责人，因为他在X平台上宣传了那个谣言，被问到了这个问题。好吧，首先，我说的一些事情可能是错误的，并且应该被纠正。所以，没有人会买一千个。我是说，我们会犯错误，但我们会迅速纠正任何错误。所以，如果，坦白说，我不确定我们是否应该把5000万美元送到任何地方。
So, Kevin, getting back to your reporting in Kenya, what exactly has been happening on the ground there as a result of this shake up in foreign aid and PEPFAR funding? Clinics were shut. Doctors were sent home. People distributing the medicine were sent home. Outreach workers stopped going to schools or places where there were vulnerable people. I mean, did they make any exceptions to the funding freeze? So, there have been efforts to restore some of this programming. On January 28th, the US Secretary of State said that life-saving programs should continue. The US Secretary of State issued a wave on the pause for life-saving humanitarian assistance during the 90-day period of review. The White House press office said in an email to the post that programs serving 85% of people who benefit from PEPFAR were up and running again, and that payments had been made to unblock, quote, the most critical bottlenecks.
好的，Kevin，回到你在肯尼亚的报道，由于外国援助和PEPFAR资助的变动，那里实际发生了什么？诊所被关闭，医生被遣散，药品分发人员也被遣送回家。外展工作人员停止去学校或有弱势群体的地方。我是说，他们对这次资金冻结有没有做出任何例外？确实，有努力来恢复一些项目。1月28日，美国国务卿表示，救生项目应该继续。美国国务卿允许在90天审查期内暂时恢复生命救助的人道主义援助。白宫新闻办公室在给《邮报》的电子邮件中表示，受益于PEPFAR项目的85%的人正在重新获得服务，并且已经进行了支付以解除“最关键的瓶颈”。
But that's not what my reporting found. Some big programs are still frozen, like those supporting HIV-positive orphans. And others are struggling to restart because so many of these programs are interconnected. So, some US-aid pet far programs were frozen, and then were given a waiver because they were considered life-saving. But the people that were supposed to distribute the money had been sent on leave. Some NGOs were granted waivers for some work, but then the other people that they were working with didn't get waivers. So, you might have a clinic that was authorized to open, but nobody being paid to go there. It's been so sudden and so unpredictable that nobody has any idea what's going to happen next.
但这不是我调查中发现的情况。一些重要的项目仍然被冻结，比如那些支持艾滋病毒阳性孤儿的项目。还有一些项目因为彼此之间的联系过于紧密，难以重新启动。因此，一些美国援助的重点项目被冻住了，但后来因为被视为救命项目而获得了豁免。然而，本该负责资金分配的人却被安排休假了。一些非政府组织获得了部分工作的豁免，但与他们合作的其他人却没有得到豁免。于是，你可能会看到一个被授权开放的诊所，却没有人获得工资去工作。这一切来得太突然，又太不可预测，没有人知道接下来会发生什么。
Okay, so let me make sure I'm understanding. So, first the Trump administration froze nearly all foreign aid. Then Secretary of State Marker Ruyo issues some exemptions, including for certain HIV and AIDS work. But even when some of that funding was in theory restored, there was so much damage to the other parts of the system that it was basically already paralyzed. The problem was by then the pavement mechanism had been dismantled. So, while you might be granted a waiver to continue your work that would exempt you from this funding freeze, there was no way to pay you.
好的，让我确保我理解正确。首先，特朗普政府冻结了几乎所有的对外援助。然后国务卿马尔科·鲁约发布了一些豁免，包括针对某些艾滋病和HIV工作的豁免。但是，即使理论上一些资金恢复了，整个系统的其他部分已经遭到严重破坏，以至于基本上已经瘫痪。问题是，到那时，支付机制已经被拆解。所以，即使你获得了继续工作、不受资金冻结限制的豁免，也没有办法支付给你。
There was so much confusion over their implementation. Sometimes you might get a waiver, for example, to open a clinic, but not one to pay the staff that were supposed to be coming there, or provide the medicine. It was a bit like putting an axe through the bottom of a boat and then saying, well, you're welcome to use this boat to cross the river. It just doesn't really work like that. You're going to sink halfway across. And unfortunately, that's what was really happening.
关于这些政策的实施存在很多混乱。有时候，你可能会获得开设诊所的许可，但却无法获得支付员工工资或提供药品的许可。这就像是在船底凿了一个洞，然后告诉你，你可以用这艘船渡河。事情并不是这样运作的，你会在中途沉没。不幸的是，这正是当时的真实情况。
So, Heather, let's go back to Mary. What has changed for her since the Trump administration put the freeze on this funding? Well, most of her income came from doing this outreach to vulnerable communities. All of us were told not to go back to work. So, we are not working. It just stops there. So, obviously her income stream has been cut. She can't pay the rent. She's been in hiding for the landlord for the last two months. Her kids have been thrown out of school because she can't pay their school fees. I've walked with her to school in the mornings and seeing the teachers turn them away. She is struggling to feed them. She might be able to make a meal just of porridge sometimes. And the HIV positive girl that she cares for has really been struggling because she's scared of dying.
好的，希瑟，让我们回到玛丽身上。自从特朗普政府冻结这笔资金后，她的情况发生了哪些变化呢？ 她的大部分收入来自对弱势社区的外展工作。我们所有人都被通知不要回去上班，所以我们现在不工作了，这一切就此停止。显然，她的收入来源被切断了。她无法支付房租，过去两个月里一直躲着房东。她的孩子因为无法支付学费被学校赶了出来。我曾和她一起早上去学校，看着老师把孩子们挡在门外。她在为孩子们的温饱而挣扎，有时候只能勉强煮一些粥。她照顾的那个HIV阳性的女孩也很难过，因为她害怕死去。
So, is she not on her medications currently? Is she able to take them? So, she is on her medications. But if you're used to getting three months of medication, and then suddenly, with no warning, they tell you, now she was given one month. Not it is like a dead sentence to the children and the women who are taking the average. The Americans have stopped funding this program and you can only have a month. And then you get down to your last couple of days. You might be scared. And I know that they have been scared that if you go to the clinic for your refill, that refill isn't going to be there. Because this was so completely sudden that there's been no opportunity for the government to plan and get extra funds to cover this kind of medication. Nobody knows how much that they actually have left.
那么，她现在没有在服用药物吗？她能否服用这些药物呢？所以，她是有在服用药物的。但是，如果你习惯了每次拿三个月的药物供应，然后突然间，没有任何预警地，他们告诉你现在她只能拿一个月的药。这对那些依赖药物的孩子和女性来说，就像是死刑一样。美国已经停止资助这个项目，所以你只能拿到一个月的药。等到药只剩下最后几天的时候，你可能会感到害怕。我知道他们很害怕去诊所续药时，会发现没有药了。因为这一切发生得太突然了，以至于政府没有时间计划和筹集额外资金来补充这些药物。没有人知道他们实际上剩下多少药物。
That sounds like a harrowing situation to be in for Mary. I think it's particularly scary for her because she's always really done her best to protect her children. And this is something that she can't protect them from. And she's gone around, you know, from clinic to clinic, you know, trying to weedle or beg or cajole doctors into giving her extra pills. It is a tough situation because when you're going to other facilities to seek for the medication, they're telling you they're not welcoming people, other new people. They have all refused because of this nationwide directive to kind of ration the medicine for now.
这听起来对玛丽来说是一个令人不安的处境。尤其对她来说更可怕，因为她一直尽全力保护她的孩子。而这次她无法保护他们。她一直辗转于各个诊所，试图哀求或请求医生给她多开一些药。这的确是一个艰难的局面，因为当你去其他地方寻求药物时，他们都说不再接收新来的患者。由于当前全国性的药物配给措施，他们都拒绝了。
Her 15 year old daughter is at boarding school across the country. And she had to send her with only one month's worth of medicine, which obviously was running out. And so the girl stopped concentrating in class. Her teacher, who was the only one who knew her status, called Mary and said, your daughter isn't doing any work now. And she says she's afraid of dying. So Mary had to find a way to get her some pills in Nairobi. And then how did you send it? With a bus. So that's more extra money? Yes, you have to, yeah, you have to be. And she managed to send them to her on a bus, which was an extra cost.
她15岁的女儿在全国另一头的寄宿学校上学。她只能给女儿带一个月的药物，显然这些药已经快用完了。于是，这个女孩在课堂上开始无法集中注意力。她的老师是唯一知道她情况的人，打电话给Mary说，你的女儿现在不做任何作业了，她说她害怕会死。所以Mary不得不想办法在内罗毕给她找到一些药。那么你是怎么寄的呢？用大巴寄的。那样不是多花了一些钱吗？是的，确实需要这么做。最终，她设法通过大巴把药寄给了女儿，这多花了一笔钱。
But she had to confide in another teacher at the school. She didn't want the girl's status to be disclosed. There's a lot of stigma around HIV. And that teacher told other teachers, and one day when the girl was not concentrating in class, one of her teachers said to her in front of her entire class. That's the cold half. And she was not hearing that it's a cold name. So she just said, why are you concentrating? Are you thinking about your HIV medication in front of all the other students? And it is so harmful. So now that all the people in her school know about this. The classroom, of course, now the school, I believe because gossiping is allowed. So now everybody knows her status and she's totally devastated. Because everybody knows now, you are living positive. We're going to die next.
她不得不向学校的另一位老师倾诉，但她不想让那个女孩的身份被泄露。关于艾滋病毒（HIV），有很多污名。然而，那位老师告诉了其他老师。有一天，当女孩在课堂上没有集中注意力时，其中一位老师在全班面前对她说了些话。这就是冰冷的事实，而她并没有意识到这是个冷酷的称呼。她只是说：“你为什么不专心？你是在想艾滋病药物吗？”这些话是在其他学生面前说的，伤害非常大。现在学校里所有人都知道了这件事，教室里、当然还有整个学校，据我所知，因为八卦盛行，所以现在人人都知道她的状况，她感到非常崩溃。因为现在每个人都知道，你是HIV阳性者，他们可能还会说：“我们下一个会死的人就是你。”
Yeah, God. So the situation that Mary's facing, how common is this across Kenya? Have you been talking with other people who are also facing these similar challenges? Yes, unfortunately, so many parents and children are facing these kinds of challenges. I went with Mary to a clinic in her neighborhood and we met a couple of ladies there. One, her name was Florence and she was the cleaner there. And she and her eldest daughter are HIV positive because when her eldest daughter was born, she didn't get that medication that stops you from passing it on to your babies. Her three youngest are HIV negative.
是的，天哪。玛丽现在面临的情况在整个肯尼亚有多普遍呢？你有没有和其他也面临类似挑战的人交流过？是的，不幸的是，很多父母和孩子都面临着这种挑战。我和玛丽一起去过她附近的一家诊所，我们在那里遇到了几个女士。其中一位叫弗洛伦斯，她是那里的清洁工。她和她的大女儿是艾滋病病毒（HIV）阳性，因为她的大女儿出生时没有得到可以防止疾病传给婴儿的药物。她的三个小孩是阴性。
And she said, her eldest daughter had been trying to comfort her by saying, you know, mom, I know things are really tough right now and you've lost your job. But at least, you know, if I die, you won't have to pay for food for me or for school fees. So you won't have to worry about that. And that's how she's trying to comfort her mom. I can't imagine as a mom like hearing your child say that. She started to cry when she was saying that and then she was saying, and what can I tell her? I can't tell her it's going to be okay because I don't know if it's going to be okay or not.
她说，她的大女儿一直试图安慰她，说：“妈妈，我知道现在的情况真的很艰难，你也失去了工作。但至少，如果我不幸去世了，你不用再为我支付食物和学费，所以你不用为这些问题担心。" 这就是她女儿试图安慰她的方式。作为一个母亲，听到孩子这样说话，我无法想象她的感受。在说这些的时候，她忍不住哭了出来，然后她说：“我能对她说些什么呢？我不能告诉她一切都会好起来的，因为我也不知道会不会好起来。”
And this woman is still turning up to clean the clinic for free. She's been there for the last two months cleaning the clinic for free just to kind of get away from her kids and get a little bit of a headspace and she's nobody's paying her and she doesn't have anything to bring home for food. So what are some of these women doing now? Are they doing anything to make money? Well, some of them are trying to go back to what they know best, which is sex work. I met this lovely lady called Tam's in a clinic with Mary. I totally got down my head to take a cause of and she asked us not to use her full name because there's still a lot of stigma about living with HIV in Kenya and she didn't want to be identified and she didn't want her children to be identified as well.
这位女士仍然坚持免费为诊所打扫卫生。过去两个月，她一直在诊所免费打扫，只是为了暂时摆脱孩子们，获得一些喘息的空间。而且没有人付给她工资，她也没有任何东西可以带回家买食物。那么，这些女性现在在做些什么呢？她们在用什么方式赚钱？其中一些人试图回到她们最熟悉的工作，也就是性工作。我在诊所里遇到了一位非常可爱的女士，她叫塔姆斯（化名），和玛丽一起来的。她请求我们不要使用她的全名，因为在肯尼亚，感染艾滋病的生活仍然有很大的污名化，她不希望自己和孩子被认出来。
She's 37. My work was dealing with the community. Like I feel the office I was talking with that, ladies and people who are living with HIV. My work was mobilizing them to pick the drugs, yeah. So how is your situation right now? The administration right now I'm trying to, I had a lot of stress, my administration now is not good. I don't know if I was a bite. She said that she had tried to go back to sex work and she couldn't get a client and then she couldn't go back home because she couldn't face her children to tell them that she had nothing to feed them.
她今年37岁。我的工作是与社区打交道。就像我之前提到的那样，我在办公室里与生活在HIV中的女性和其他人交流。我的工作是动员他们去领取药物。那么，你现在的情况怎么样？目前的管理状况让我感到压力很大，我的行政状况不太好。我不知道我是不是被咬了。她说她尝试回到性工作行业，但找不到客户，也不敢回家，因为她无法面对孩子，告诉他们她没有办法喂饱他们。
If these clinics aren't there, if people like Tam's and Mary can't do the outreach that they've been doing, are we expecting to see the rates of HIV increase again? So there has been some modeling by UNAIDS that shows if all pet far funding is caught, the death rate will spike higher than it was 20 years ago. It will be the worst it has ever been in terms of deaths and infections. It's active in 55 countries around the world. It supplies life-saving medicine to more than 20 million people right now, including 560 thousand children.
如果这些诊所不存在，像Tam和Mary这样的人无法进行他们一直在做的外展活动，我们是否预计看到艾滋病感染率再次上升？联合国艾滋病规划署进行了一些模型预测，结果显示如果所有的资金都被削减，死亡率将比20年前更高。这将是历史上死亡和感染情况最严重的时期。目前，这项服务活跃于全球55个国家，为超过2000万人提供救命药物，其中包括56万名儿童。
So if pet far was permanently halted, UNAIDS estimates that there would be an additional 6.3 million AIDS-related deaths, 3.4 million AIDS orphans, 350 thousand new HIV infections among children and 8.7 million new adult infections by 2029. So that's just in the next four years. It doesn't look like all pet far funding is going to be caught. So hopefully, you know, we won't see it go that high, but we know certainly that it is going to jump.
如果全球抗击艾滋病的计划（PEPFAR）被永久停止运行，联合国艾滋病规划署（UNAIDS）估计，到2029年，额外将有630万艾滋病相关的死亡，340万艾滋孤儿，35万名儿童新增HIV感染，以及870万例新的成年感染病例。这些数据只是接下来的四年内可能出现的情况。目前看来，PEPFAR的资金并不会被完全切断。希望我们不会看到情况变得如此糟糕，但很明显感染人数将会有显著增加。
Now how far it's going to jump? We just don't know. So Katherine, has there been a push to restore these funds? Has there been any outcry that these funds have been cut? So yes, I mean, there's been strong bipartisan support for pet far. A lot of health advocates and a lot of lawmakers from both sides of the aisle have spoken out in support of it. And I think that's the reason why some programs did get waivers. We've also seen legal challenges to this executive order. The AIDS vaccine advocacy coalition filed a lawsuit on February 10 against the foreign aid freeze. The problem is, you know, these lawsuits have seen a lot of temporary state orders, you know, that might last for a week. It's not really clear what's going to happen next. So basically, the sort of the chaos continues. And nobody knows what's going to happen week to week.
现在，我们不知道事情将如何发展。所以，Katherine，是否有人推动恢复这些资金？有没有因为资金被削减而引发强烈抗议？是的，实际上，对“宠物基金”有着强烈的两党支持。许多健康倡导者和两党的议员都公开表示支持。我认为这也是一些项目获得豁免的原因。我们也看到对这一行政命令的法律挑战。艾滋病疫苗倡导联盟在2月10日对外国援助冻结提出了诉讼。问题在于，这些诉讼通常只获得临时的州令，可能只持续一周。接下来会发生什么，并不明确。所以，基本上，这种混乱仍在继续，没有人知道每周会发生什么。
Katherine, I know that the post has also reported that since the legal challenges you mentioned were filed, the Trump administration has moved to formally close USAID. And so I imagine there's likely going to be more challenges and more uncertainty. I think there might be some people listening who will wonder, why is it the US's responsibility to maintain these programs and support these families across the globe? Does the Trump administration have a point, you know, that the US should scale back its support around the world? So I think that's a very broad question. So to what extent do we as humans have the responsibility to help other humans?
凯瑟琳，我知道媒体也报道说，自从你提到的法律挑战被提出后，特朗普政府已经采取行动，正式关闭美国国际发展署（USAID）。因此，我想很可能会有更多的挑战和不确定性。我认为可能会有一些听众会感到疑惑，为何美国有责任在全球范围内维持这些项目并支持这些家庭？特朗普政府是否有道理，美国是否应该减少对全球的支持？我认为这是一个非常广泛的问题。我们作为人类，在多大程度上有责任去帮助其他人类呢？
This was perhaps one of the most important global health fights of our time. And it was one of the most shining examples of American soft power, one of the greatest public health victories on par with the eradication of smallpox. I think one of the things that Mary's story also has shown us is that when you give somebody just a tiny little bit of help, like a little bit of respite, they can go a long way towards making their community and their country a better place. You know, so Mary had this little stipend and a little bit of food and as a result of that, she was able to set up an organization that helped 700 people. She actually ran for a local office as a local counselor in the last election and she lost, but she is out there organizing demonstrations, teaching people how to fight for their rights, trained herself as a paralegal.
这可能是我们这个时代最重要的全球健康斗争之一。这也是美国软实力最辉煌的范例之一，是与消灭天花齐名的伟大公共健康胜利。我认为，玛丽的故事还向我们展示了，当你给予一个人一点点帮助，比如稍微喘息的机会，他们可以在改善社区和国家方面走得更远。你看，玛丽得到了一个小小的补贴和一点食物，因此她不仅成立了一个帮助700人的组织。她还在最近的选举中竞选地方议员，虽然没有当选，但她积极组织示威，教导人们如何维护自己的权利，还自学成为了一名法律助理。
And the way that she was able to do that was with just a tiny little bit of help from the American government. And Kenya was well on its way to getting the disease under control. And now it might not be. The disease is going to cross borders. Sex workers are going to sleep with tourists, people whose medications are interrupted might develop drug-resistant strains of the disease and pass that on. And those strains are much, much more expensive to treat. So the problem is that when you have a deadly disease, it does threaten everyone and it doesn't respect borders and that's what Mary told me. HIV is not for African-only, HIV is not for Kenya only, she'd understand that.
她能够做到这一点，只是得到了美国政府的一点小小帮助。肯尼亚正顺利地控制住这种疾病。然而，现在情况可能不妙。这种疾病将跨越国界传播。性工作者会与游客发生关系，药物中断的人可能会发展出耐药菌株，并将其传染给他人。而这些菌株的治疗费用高得多。所以问题在于，当你面对一种致命的疾病时，它会威胁到所有人，不分国界。正如玛丽告诉我的那样，艾滋病不是仅仅属于非洲的，也不是仅仅属于肯尼亚的，她对此很清楚。
Katherine, thank you so much for joining us. Thank you. Katherine Horold is an aerobic correspondent for the Post. That's it for Post Reports. Thanks for listening. If you're looking for the latest updates on the big news of the day, check out our morning news briefing, The Seven. We bring you the seven stories you need to know about every weekday morning by 7am. You can listen to it wherever you listen to podcasts. Today's show was produced by Alana Gordon. It was mixed by Sean Carter and edited by Lucy Perkins. Thanks also to Jesse Mezzarhaj and Jan Amher. I'm Cole B. IcoWitz. We'll be back tomorrow with more stories from the Washington Post.
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