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[资源] 艾滋的25年—造福穷人，《CELL》杂志

25 Years of HIV/AIDS Science: Reaching the Poor with Research Advances

爱滋科学的25年：让先进的研究成果为穷人造福

Last year marked the 25th anniversary of the recognition of what we now call AIDS. The AIDS pandemic has claimed more than 25 million lives, the majority of them in the developing world, and has exacerbated poverty and slowed human development. Although much has been accomplished in HIV/AIDS research, much remains to be done, especially regarding delivery of HIV/AIDS therapies and care and prevention interventions to the poorest countries that need them most.

去年是AIDS发现25周年。艾滋已经夺取了超过25，000，000条生命，主要病发地——发展中国家因此而蒙受了巨大的损失：贫困恶化，人口发展减慢。尽管人类已经在艾滋病的相关研究上取得了很多成果，但仍然有很多问题等待解决，尤其是向最需要帮助的贫穷国家提供帮助，进行艾滋病治疗，护理，预防以及干涉等。

By the end of 2006—25 years after the first reported AIDS cases in the United States—the HIV/AIDS pandemic had claimed more than 25 million lives globally (UNAIDS/WHO, 2006). What began as a handful of recognized cases among homosexual men in the early 1980s has become a global pandemic of such proportions that it clearly ranks as one of the most destructive microbial scourges in history ([UNAIDS, 2006] and [Fauci, 2006]).

25年前，美国报告了第一例艾滋病例，截止到2006年底全球的艾滋病报告人数已经上升到25，000，000（UNAIDS/WHO, 2006）。20世纪80年代早期检验出的病例中，只有一小部分是因为男性同性恋者间传播，这已经成为艾滋病传播的最主要的方式。艾滋病现已被划为历史上微生物感染引起的最具毁灭性的疾病之一。

This Commentary is part of the Council of Science Editors' Global Theme Issue on Poverty and Human Development comprising 1000 articles on this theme published simultaneously by 235 journals worldwide.

注释为科学杂志编辑委员会关于全球主题的贫困和人类发展问题，涵盖了1000篇已在全求235家杂志上发表的主题相关文章。

Of the about 40 million people living with HIV, the vast majority live in resource-poor settings, notably countries of sub-Saharan Africa where food insecurity and endemic infections such as tuberculosis, malaria, and a range of parasitic diseases are also common (UNAIDS, 2006). Of the 62 countries most affected by HIV (nations with adult HIV seroprevalence rates >1% or with large numbers of persons living with HIV), 40 are in sub-Saharan Africa, 5 in Asia, 12 in the Americas and the Caribbean, 4 in Europe, and 1 in Oceania (United Nations Population Division, 2006). According to the United Nations Population Division, life expectancy in southern Africa as a whole has fallen from 61 to 49 years over the last 20 years. In the countries hardest hit by HIV/AIDS, the situation is even more severe: in Zimbabwe, for example, estimated life expectancy at birth is only 34 years for women and 37 years for men.

近40，000，000的HIV携带者中，大部分生活物资低下，尤其是撒哈拉以南的非洲地区，那里食物不安全性大，地方性疾病感染盛行，如肺结核，疟疾，还有很常见的寄生虫病 (UNAIDS, 2006)。在HIV感染最严重的62个国家中（成年人HIV血清阳性比例大于1%或有大量HIV携带者的国家中），40个都属于撒哈拉以南的非洲国家， 4个在亚洲，12个在美洲和加勒比海，4个在欧洲，一个在大洋洲(United Nations Population Division, 2006)。按照美国人口划分，南非的人口平均寿命已经从20年前的61岁下降到49岁。在遭受HIV最惨重的国家，情况更为糟糕：比如在津巴布韦，依据人口出生率估计人均寿命，女性34岁，男性37岁。

In addition to the enormous human tragedy associated with HIV/AIDS, the economic costs are staggering, posing serious impediments to the growth and stability of many developing countries (Bertozzi et al., 2006). HIV/AIDS has disproportionately affected young and middle-aged adults who are the mainstays of economies and the breadwinners for families. In many developing countries, previously realized gains in economic and social development have been reversed as HIV/AIDS has reduced the labor supply and productivity and depleted limited pools of skilled workers, teachers, and managers. In communities with large numbers of HIV-infected individuals, poverty and other development challenges have worsened. An exacerbation of poverty in turn reduces job opportunities and makes populations more vulnerable to the spread of HIV.

HIV不仅带来惨痛的人类悲剧，而且带来巨大的经济负担，严重阻碍许多发展中国家的发展和稳定(Bertozzi et al., 2006)。HIV/AIDS大量侵害那些年轻的和中年人，而这些人本该成为经济发展的中流砥柱和家庭的经济支柱。在许多发展中国家，艾滋病使得劳动力供应和生产力水平下降，随着数量有限的高技术性工人，教师，管理人员资源的耗尽，已发展起来的经济和社会倒退发展。因为拥有数量庞大的HIV感染者，这些国家贫穷和其他方面的发展状况更加恶化。贫困的加剧又导致就业机会减少，从而使得HIV的传播更为普遍。

As the humanitarian and economic burden of HIV/AIDS has grown, so too has the biomedical research response to the pandemic, providing important opportunities to mitigate the impact of HIV/AIDS on health and economic development. Funding for HIV/AIDS-related research is unprecedented in magnitude, larger than for any other single disease in history (Folkers and Fauci, 2001). At the US National Institutes of Health alone, >$30 billion has been spent on HIV/AIDS research since the beginning of the pandemic (Fauci, 2006). The returns on these investments have been substantial (reviewed in Fauci, 2003). Within 3 years of the recognition of the first AIDS cases in 1981, the etiologic agent of the syndrome was discovered and causality proven. In 1985, a sensitive and specific diagnostic assay for HIV antibodies was developed. This test and its descendents have been used in epidemiological studies to illuminate the scope of the epidemic, as well as to safeguard blood supplies. Molecular studies of HIV have delineated the genetic and structural organization of the virus and the mechanisms that regulate its replication. This information and related research on HIV pathogenesis has facilitated the rapid development of antiretroviral drugs (ARVs) that limit HIV replication and immune system damage, as well as tools to monitor levels of virus in the blood and immune status. More than 25 antiretroviral drugs are now available to treat HIV infection, and these medications have had an enormous impact in reducing morbidity and mortality wherever they have been used (WHO/UNAIDS/UNICEF, 2007). New ARVs such as integrase, maturation, and entry inhibitors, as well as next-generation reverse transcriptase inhibitors and protease inhibitors, have been licensed or are in late-stage clinical development. These drugs hold great promise, especially for patients who have failed their current regimens due to drug resistance or other factors (Siegel and Gulick, 2007).

随着对HIV的人道主义及经济负担加重，生物医药研究为减轻其在健康状况改善和经济发展方面做出了重要贡献。HIV/AIDS相关研究设立的基金空前巨大，大大超过历史上任何一种疾病(Folkers and Fauci, 2001)。拿美国国家健康研究所为例，艾滋病报告第一例至今，在HIV/AIDS研究上已经花非了尽$30，000，000，000(Fauci, 2006)。这些投资还来的回报也是实实在在的(reviewed in Fauci, 2003)。通过对1981年第一例艾滋病近3年的研究认识，综合症的病原学特征基本被弄清楚并得到证实。1985年，第一个HIV敏感的专一性抗体检测方法建立。这个方法又衍生出一些其他方法，应用于流行病学研究中，帮助阐明流行病的种类，为输血安全把关。HIV的分子研究给出了病毒遗传和结构组织，以及其调控复制的机制。这些成果与相关的HIV病理发病研究的结合，极大地推动着抗逆转录病毒药物（ARVs）迅速发展。抗逆转录病毒药物的作用就是阻碍病毒复制，降低免疫系统损伤。不仅如此，一些用于检测血液和免疫系统中病毒水平的工具也发展起来了。现如今，有超过25种抗逆转录病毒被用于HIV感染的治疗，并且无论在何处，它们都正发挥着极其巨大的作用，减少了发病率，也降低了死亡率(WHO/UNAIDS/UNICEF, 2007)。新的抗逆转录病毒药物，例如抑制整合酶，成熟，侵入的抑制剂，及下一代逆转录抑制剂和蛋白酶抑制剂，都已经通过许可，正在完成最后的临床实验。这些药物有着极大的前景，尤其是对于那些由于抗药性和其他因素导致治疗失败的携带者而言(Siegel and Gulick, 2007)。

Encouragingly, growing numbers of HIV-infected individuals in need of ARVs in low- and middle-income countries are receiving them. A growing body of evidence has shown that the immunological and virological responses to ARVs in both adults and children in poor countries can be as good as those in industrialized settings. ARV prices have fallen dramatically: the average annual cost in low- and middle-income countries of a common first-line ARV regimen consisting of 3 medications was <$150 in 2006. Programs such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis, and Malaria, nongovernmental organizations such as Medecins Sans Frontieres, and philanthropies like the Bill and Melinda Gates Foundation and the Clinton Foundation helped deliver ARVs to >2 million individuals by the end of 2006, up from 400,000 in December, 2003 (see Figure 1) (WHO/UNAIDS/UNICEF, 2007). This progress demonstrates what can be accomplished even in the developing world with increased funding, a strong global commitment, collective action, and political will.

令人鼓舞的是，中低收入国家的HIV感染群体也能用得起这些药。不断有证据显示，无论是贫穷国家还是发达的工业国家，ARVs在成年和儿童体内能引起相似的免疫学和病毒学反应。ARVs的价格极大地降低：2006年中低收入国家中，治疗的第一疗程普通含三支药的ARVs平均低于150美圆。截至2006年底，美国总统的AIDS紧急救济计划(PEPFAR)，全球为对抗AIDS，肺结核，疟疾设立的基金，非政府组织如无国界医生，慈善机构如Bill和 Melinda Gates基金会，克林顿基金会等，令超过2，000，000人得以用上ARVs，这一数据在2003年12月是400，000（见图1） (WHO/UNAIDS/UNICEF, 2007)。这些进步显示通过增加基金，增强全球合作，团结行动联合政治意愿，即便在发展中国家也能得以实现。

Significant progress also has been made in HIV prevention. The risk factors associated with HIV transmission are well defined, and proven methods to prevent sexual HIV transmission (e.g., behavior change programs, condom promotion), blood-borne HIV transmission (e.g., needle/syringe exchanges), and mother-to-child transmission (e.g., ARVs) have been deployed throughout the world (Global HIV Prevention Working Group, 2007). No single intervention is a magic bullet but when deployed in combination can have an important impact, as evidenced by well-documented success in Brazil, Thailand, Uganda, Senegal, and other countries, both rich and poor.

在HIV预防方面也取得了重要进展。HIV传播相关的危险因素都已被定义。被用于预防HIV性传播（如行为改变活动，鼓励使用避孕套），血液传播（如针头 /注射器互换）和母婴传播（如ARVs）的验证性方法已经在全世界开展(Global HIV Prevention Working Group, 2007)。单独的干涉并不能成为魔法子弹，但如果联合开展就能引起重要作用，已有大量证据显示在巴西，泰国，乌干达，塞内加尔，及其他无论是发达还是贫穷的国家，已经取得了成功。

Promising research on new prevention interventions holds hope for adding new tools to the HIV prevention armamentarium, such as adult male circumcision, topical microbicides, pre-exposure chemoprophylaxis with well-tolerated ARVs such as tenofovir, and an HIV vaccine (Bertozzi et al., 2006). A preventive HIV vaccine remains the greatest hope for reversing the relentless spread of HIV, and clinical trials of diverse approaches are ongoing throughout the world (Johnston and Fauci, 2007). Even an “imperfect” HIV vaccine would have enormous benefits. In this regard, progress has been made in developing so-called T cell-based HIV vaccines, which evoke cell-mediated immunity that may not protect against infection but could nonetheless help lower the initial burst of viremia following infection as well as the viral set point and slow disease progression and reduce transmissibility. Meanwhile, structural studies of the HIV envelope may lead to the development of immunogens that elicit broadly neutralizing antibodies that could form the basis of a “sterilizing” vaccine that blocks infection altogether (Johnston and Fauci, 2007).

颇有前景的新型预防干涉为HIV防御增添了新途径，如成年男性割包皮，局部杀菌剂使用，针对耐ARVs使用的预暴光化学疗法，HIV疫苗 (Bertozzi et al., 2006)。一种预防HIV的疫苗是扭转HIV之战现状最有力的希望，不同方法的临床实验都正在世界各地展开(Johnston and Fauci, 2007)。即使是一个带有瑕疵的HIV疫苗也会带来巨大的利益。在这个意义上，发展起来一种被称为基于T细胞的HIV疫苗，它能唤起细胞介导的免疫，这种保护作用也许对于抵抗感染作用不大，但能减低减轻病毒感染引发的首次病毒血症，减缓发病，降低传播性。同时，HIV外壳的结构学研究也许带来免疫原的发展，从而促使产生大量的抗体，形成杀毒的疫苗，将感染完全封闭掉(Johnston and Fauci, 2007)

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While extraordinary scientific, medical, and public healthaccomplishments have been made in the battle against HIV/AIDS, muchremains to be done, especially with regard to delivering the fruits ofthe research endeavor to resource-poor countries where the pandemiccontinues to destroy lives, communities, and societies in staggeringnumbers (Global HIV Prevention Working Group, 2007). Evidence-based HIVinterventions are needed at high levels of coverage, uptake, intensity,and duration if they are to have a significant public health impact.Priorities include the effective scale-up of HIV/AIDS therapy, care,and prevention, training of health care workers and ancillarypersonnel, support of orphans and vulnerable children, and thestrengthening of health care systems and infrastructure in HIV-burdenedregions (UNAIDS, 2006). Each of these will require an increased andsustained infusion of resources from rich countries and other donors.It is encouraging that annual spending on HIV/AIDS in poor- andmiddle-income countries increased six-fold between 2001 and 2007 toapproximately $10 billion, but this sum represents less than half theamount that UNAIDS estimates will be needed in 2008 for the expandedresponse needed to slow the pandemic.

在这场面对HIV/AIDS的战争中，科学，医学和公共健康已经取得了卓越的成就，但仍然有很多待解决的问题，尤其是把研究成果投送给资源匮乏国家，那里流行病正肆虐，以令人吃惊的速度吞噬人们的生命，毁灭一个团体，一个社会(Global HIV Prevention Working Group,2007)。如果这些预防措施能对公共健康起到重要作用，覆盖广，改善，强烈，持续时间长的状况要求基于证据的HIV预防。前提包括 HIV/AIDS治疗的有效比例规模，护理，预防，健康护理工作人员及辅助人员的培训，孤儿及弱势儿童的教养，健康护理体系的加强，HIV肆虐地区相关机构设施的构建(UNAIDS,2006)。任何一样都要求从发达国家和其他的捐助者能够提供更多的资源并维持这种帮助。令人欣慰的是，中低收入国家每年用于HIV/AIDS的花费相比2007年达到10，000，000，000美圆，是2001年的6倍，但这笔花销相比联合国艾滋病规划署预计2008年用于减缓流行病蔓延趋势的费用，还不到一半。

Despite the progress with ARV access noted above, huge gaps remain inthe provision of these life-saving drugs. Only 28% of people (and just15% of children) in need of ARVs in low- and middle-income countriesare receiving them, and problems of access persist in developedcountries as well (see Figure 1). A shortage of trained health careworkers remains an important rate-limiting factor in the scale-up ofHIV treatment and prevention services, especially in Africa. The WorldHealth Organization (WHO) has estimated that Africa bears not, vert,similar24% of the global burden of all diseases but has only 3% of theworld's healthcare workforce. Of 57 countries that do not meet basicstandards of healthcare coverage by doctors, nurses, and midwives, 36are in Sub-Saharan Africa (Kumar, 2007). Significant resources areneeded to train doctors and nurses in resource-poor areas, as well ascommunity healthcare workers to provide care for HIV/AIDS and otherdiseases in their home villages and neighborhoods. The model ofcommunity-based care provided by closely supervised “accompagnateurs,”trained community health workers who use simplified algorithms fordiagnosis and treatment, has been validated in both rich and poorcountries and must be better utilized ([Kim and Farmer, 2006] and[Mukherjee et al., 2003]). Operational and clinical research isessential to guide the formulation of such algorithms and to assesstheir utility on a larger scale.

通过以上介绍，尽管ARV已经取得了进展，但这些“救命药”的供应仍然困难重重。中低收入国家中，需要ARVs治疗的HIV携带者中，只有28%（和 15%儿童）得以使用ARVs。同样在发达国家也有这样的情况（图一）。卫生护理专业人员的短缺是其中一项限速因素，为增加HIV治疗及预防服务的开展带来障碍，这在非洲尤为突出。世界卫生组织（WHO）估计非洲含盖了全球24%的疾病，却只有世界3%的卫生护理人员。在57个未达到卫生保健标准的国家中，36个在撒哈拉以南地区的非洲，这些标准指的是医生，护士，助产士的素质(Kumar,2007)。在资源匮乏的国家，培养医生和护士所需的资源非常重要，同样的，卫生团体的工作人员需要花更多的精力在HIV/AIDS和其他本土及邻近地区流行的疾病。严格监控的所谓“指南”，用于训练那些应用单一化方法进行诊断和治疗的团体公共卫生工作者，这种以团体为基础的护理模式，已经在发达国家和贫穷国家推行提倡([Kim and Farmer, 2006] and [Mukherjee et al.,2003])。可操作性的临床研究是令这些方法大范围得到充分利用的基本条件。

Infrastructure and personnel for the medical monitoring of ARV therapyare lacking in most poor communities (Koenig et al., 2006). Clearly,limited resources should first be used to scale-up ARV treatment andprovide basic support to patients to achieve good treatment adherenceand minimize resistance. As rapidly as possible, however, laboratorycapacity must be improved to allow the monitoring of virological andimmunological outcomes of ARV therapy, as well as toxicities, such thattreatment regimens can be optimized (Koenig et al., 2006). Increasedfunding also is needed to provide services that allow poor people toovercome the social and economic impediments to successful adherence toHIV/AIDS treatment and care. So-called “wrap-around services”frequently include food supplements, transportation to clinics, childcare, and housing, as well as care for concomitant diseases ([Kim andFarmer, 2006] and [Mukherjee et al., 2003]).

建立ARVs治疗的药物监控，需要有组织，还有有人员，这在大多数贫穷国家中奇缺 (Koenig et al.,2006)。很明显，有限的资源应当首先被用于增加ARVs治疗，并提供病者基本的保障，令他们维持良好的治疗效果并使耐药性降到最低。然而，实验室的科研能力必须得到提高，使ARVs治疗的病毒学及免疫学及毒性状况得以监控，并得到优化，这一点越快实现越好(Koenig et al.,2006)。不断增加的基金，使穷人享受服务成为可能，他们可以摆脱社会和经济束缚，得到HIV/AIDS治疗和护理。这种被称为“包卷打法的服务”，包括食品供应，临床输送，儿童照看，住房，及并发症的治疗 ([Kim and Farmer, 2006] and [Mukherjee etal., 2003]).

Striving for universal access to ARVs is a public health and ethicalimperative; however, it may be logistically impossible to reach thisgoal, as six people were newly infected with HIV in 2006 for everyperson put on treatment (WHO/UNAIDS/UNICEF, 2007). Therefore, HIVprevention activities, hopefully with, but possibly without, a safe andeffective HIV/AIDS vaccine will determine the trajectory and burden ofthe HIV/AIDS pandemic in the years and decades ahead. Today, fewer thanone person in five at risk of becoming infected with HIV has access toHIV prevention services, which even when available are confounded bycomplex cultural and societal issues (Global HIV Prevention WorkingGroup, 2007). For example, a condom is used in only 9% of sex actsinvolving nonregular partners. Just 10%–12% of adults in the mostheavily affected countries in sub-Saharan Africa have been tested andknow their HIV serostatus. In developed countries, near-universalprovision of ARVs to prevent mother-to-child transmission (PMTCT) hasreduced perinatal infection rates to <1%–2% in many cohorts;however, in developing countries, just 11% of HIV-infected pregnantwomen receive ARV prophylaxis for PMTCT. Prevention services reach avery low proportion of individuals in poor countries at highest risk ofHIV infection: just 9% of men who have sex with men, 8% of injectiondrug users, and <20% of commercial sex workers (Global HIVPrevention Working Group, 2007).

普及化ARVs是一项迫切的公共卫生及伦理需求。然而，逻辑上而言这也许是不可能的，因为如果2006年只有6个人感染HIV，那么这6个人都能得到治疗 (WHO/UNAIDS/UNICEF,2007)。因此，尽管我们希望安全有效的HIV/AIDS疫苗能成为HIV预防措施，在未来数年至数十年艾滋病的发展轨迹及流行趋势，但很可能实现不了。如今，可能转变为HIV携带的人中，有超过1/5的已经享受到HIV预防服务，但复杂的文化和社会背景仍然阻碍这一进程(Global HIVPrevention Working Group, 2007)。例如，非正规的性交活动中只有9%使用避孕套。即使在感染严重的撒哈拉沙漠以南的非洲国家中，只有10%至12%做过HIV检查和知道自己的感染情况。而发达国家几乎提供普及化的ARVs供应，预防母婴传播，许多地方围产期传染的比例降到低于1%至2%。然而，在发展中国家，携带HIV的孕妇中，只有11%得以使用ARVs预防母婴传播。HIV高感染的贫穷国家中，预防服务只开展了非常小的一部分：同性性史的男性当中的9%，药物（毒品）感染者中的8%，商业性活动从事者中低于20%的人得到预防治疗服务。

The delivery of proven prevention services is imperative: half of the60 million HIV infections projected to occur globally between 2005 and2015 could be averted with comprehensive scale-up of proven preventionstrategies, according to a recent estimate (Global HIV PreventionWorking Group, 2007). In scaling up prevention services, importantlessons can be drawn from common elements of the HIV/AIDS preventionefforts in those countries that have had success in reducing HIVinfections. Such factors include the strong support of politicalleaders and the use of the media to raise HIV awareness; efforts toencourage respect, tolerance, and compassion for HIV-infected people;adequate and sustained funding; the use of evidence-based strategiesbased on a detailed understanding of the specific dynamics andepidemiology of the epidemic in a particular setting; and theinvolvement in the prevention effort of diverse sectors, includingcommunity groups and religious leaders (Global HIV Prevention WorkingGroup, 2007).

有效预防服务的开展需要强制性：最近估计显示，2005年至2015年，通过有效预防策略能使全球60，000，000例的HIV感染降低一半 (Global HIV Prevention Working Group,2007)。在增大预防服务的同时，可以像那些HIV/AIDS已经得到有效控制的国家取经。包括政府机构的强力支持，应用媒体引发公众对 HIV的警惕意识，鼓励对HIV感染者的尊重，宽容和同情，足够的，源源不断的基金，建立于对专一动力学和流行病学独特框架下的政策运用，各层人民预防所做的努力，包括团体组织和宗教领袖(Global HIV Prevention Working Group, 2007).

Concomitantly, further research is needed on how best to deliver adultmale circumcision (a prevention tool with significant efficacy inclinical trials) and integrate it into existing health services.Research also is needed to prove the efficacy and feasibility of otherpromising HIV prevention approaches such as topical microbicides,pre-exposure chemoprophylaxis, and an HIV vaccine (Johnston and Fauci,2007). Each of these interventions could have a significant impact onthe course of the HIV pandemic, as part of a multifactorial preventioneffort.

同时，未来的研究会朝向探寻如何使成年男性割包皮（临床上已经发现非常有效的一种预防手段），并会应用于现有的公共卫生医疗服务。其他有效可行的HIV预防方案也正在研究中，例如局部杀菌剂，预爆光化学预防，以及HIV疫苗的研发(Johnston and Fauci,2007)。每种预防方案在针对HIV的多因子预防进程中，都起着各自重要的作用，

A truly comprehensive approach to HIV disease will require a commitmentto overcoming the stigma and discrimination frequently associated withHIV infection (UNAIDS, 2006). The medical consequences of stigma anddiscrimination are serious because HIV-infected people may avoidlifesaving treatment and suffer needlessly. In addition, thepsychological toll of isolation and ostracism can be profound, to saynothing of the physical violence to which HIV-infected people aresometimes exposed. Because of stigma, at-risk people may avoid HIVtesting altogether, missing opportunities for needed treatment andopportunities to access prevention programs that could help them avoidinfecting others.

艾滋病综合治疗方法要求能够保证并迅速克服对于HIV感染者的羞辱和歧视(UNAIDS,2006)，羞辱和歧视能带来非常严重的医学后果，因为HIV感染者也许会因此而拒绝治疗，而遭受很多不必要的痛苦。此外，孤立和排斥带来的心理影响非常巨大，他们身体上遭受的痛苦就更不必说了。因为羞辱感，状况危险的病者会拒绝接受完全的HIV检查，错失很多必要治疗的机会，也错失很多避免感染其他人的预防机会。

As we enter the second quarter century of AIDS, we are at a pivotaljuncture: there have been substantial scientific advances, yet manyinfected people are dying needlessly and HIV infection is stillspreading. Collectively, we must do more to slow the spread of HIV/AIDSby scaling up the availability of proven treatments and preventiontools. We must eliminate stigma toward and discrimination againstpeople with HIV and refine and validate the efficacy of existingtreatment and prevention programs. We must further elucidate thepathogenesis of this complex disease and develop improved treatmentsand tools for prevention. Perhaps most important, public healthworkers, policymakers, and activists must bring the benefits ofadvances in treatment and prevention research to the people who needthem most.

我们对抗艾滋已经进入到第二个1/4世纪，我们处在一个关键的接合点：科学研究仍然在进展，然而那些不必要死去的感染者挣扎在垂死的边缘，HIV感染继续蔓延。总之，我们必须做更多的工作减缓HIV/AIDS的蔓延，方法就是寻找到这个复杂综合症的发病机理，不断发展可行有效的疗法，增加预防手段。也许最重要的一点，公共卫生的工作人员，立法人员，以及行动主义者们能够令最需要帮助的人们受益，也即把先进的治疗方法和预防研究带给他们。