編譯■賴明芝、實習記者林毓蓉

全球人口數直線上升，已突破60億大關，伴隨人口快速成長而來的，就是貧富不均現象。貧窮國家在沉重的人口壓力下，原本糧食不足、資源缺乏的情形也日趨惡化，帶來最嚴重的後果，就是使得國家人口健康普遍不良，然而，在醫療資源的分配上，卻也陷入「貧者愈貧，富者愈富」的窘境中。

席捲全球的愛滋病就深受貧富不均現象影響，以非洲國家為例，根據世界衛生組織估計，2000年底非洲約有2,870萬人感染，1,930萬人死亡，卻只有極少數人能接受治療。現在，雖然接受治療人數增加，但是感染的人數增加得更快。由於非洲許多國家經濟落後、生活貧困，不僅醫療資源缺乏，人民遍缺少衛生觀念，經由輸血、消毒不完全的醫療器材而感染愛滋的案例屢見不鮮，在人口數暴增的同時，感染人數也不斷飆昇，一連串交互作用下，造成愛滋病在非洲地區肆虐，也帶來許多家庭、社會，甚至是國家問題。

然而，最慘的是，由先進國家發展出的藥物，成本非常昂貴，這些「每人日所得低於一美元」的貧窮國家，根本負擔不起，更別提平均分配這些醫療資源。北美與西歐等先進國家，因為有雞尾酒療法等愛滋藥物的使用，疫情則能逐漸緩和。而非洲在2002年的時候，花了10億美元對抗愛滋病，估計4千萬名愛滋感染者當中，就有3千名在非洲。

全球局勢牽一髮動全身，在這個地球村的時代，遏止愛滋病擴散已不是單單一個國家的責任，雖然世界強國承諾投入大量物資對抗愛滋蔓延，第三世界國家也曾尋求富國協助，但總是口惠而實不至；在過去5年中，美國曾經承諾以150億，特別給予非洲國家來對抗愛滋，但明年卻只會撥出20億經費投入此計畫。

本月稍早，世界衛生組織展開了一項計畫，打算在2005年將提供全球3百萬名窮人能夠救命的抗愛滋藥物ARN，並訓練一萬名的醫護人員。

而2003初的時候，英國也表示，到2008年為止將提供2億8千萬美元做為全球愛滋基金；2001年的時候，英國政府本來承諾的內容是，5年內給予2億美元的資助。

The head of the World Health Organization on Sunday urged rich nations to provide more money to fight AIDS, which is devastating African nations.

WHO Director General Jong-Wook Lee called on Britain, Japan and Scandinavian nations in particular to donate more money to the organization's global push against the disease, estimated to be killing 8,000 people a day.

"The trend is more money is becoming available, we have to put in more requests and suggestions and pressure to the countries," said Lee, in Brazil for a global health conference.

He said "very urgent action and not the business-as-usual approach" was needed.

Funding to battle HIV/AIDS has increased from $3.2 billion in 2002 to $4.7 billion but is still less than half the yearly total the United Nations has called for to fight the epidemic and provide drugs to treat people infected by HIV.

The WHO earlier this month unveiled plans to rush life-saving antiretroviral (ARV) AIDS drugs to 3 million of the world's poor by 2005 and train 10,000 health workers.

Lee said HIV had now infected nearly 40 percent of people in Botswana and half the population would die of AIDS unless urgent action was taken. Life expectancy in Mozambique is expected to fall to 27 years due to the disease.

In 2002 around $1 billion was spent on fighting HIV and AIDS in Africa, which is thought to have nearly 30 million of the 40 million people infected by the disease.

The United States has promised $15 billion over five years to combat AIDS, especially in Africa. It has come under fire for only earmarking $2 billion for the program next year.

Earlier this year, Britain said it would give a global AIDS fund $280 million through to 2008 after initially pledging $200 million for five years in 2001.

愛滋病自發現後，就以驚人的速度在全球蔓延開來，其發病率和死亡率都在逐年上升，尤其又以醫藥條件缺乏和性氾濫的非洲更為嚴重。以南非為例，在這個全球愛滋病發病率最高的地區，整個國家的人口死亡率不但急速增加，國民的生產力也相對下降，影響南非整體經濟狀況。南非的愛滋病疫情甚至也在企業界引發衝突，連帶地，勞工們的福利也受到影響。

早在前幾年前，就有人壽保險專家預測，愛滋病的危機和傳染病的蔓延，會使南非再次重新審視勞工的福利問題。美商大都會人壽的資深經理彼得．多伊爾也表示，大部分在工作期間得到愛滋病的勞工，都不能馬上領到公司的保險理賠，必須等上好一段時間才能領到。所以，多伊爾認為，南非雇主、保險公司和勞工工會三方，必須好好討論，進行協商，使三方面都能達到最大利益。

現在南非愛滋病仍然非常嚴重，向雇主申請愛滋病保險的員工也越來越來多，但是，許多企業界卻認為，發病的勞工生產力會逐漸降低。再加上調高的保險費會增加人事成本，南非企業因而常感到不堪負荷。對於這種情形，有專家表示，南非如果無法降低申請愛滋病被保險者的數量，政府也不能提供有效的醫療照護，絕大部分的勞工在未來3到5年內，就得面臨雇主極有可能無法再為員工投保的情形。

South Africa is following the rest of sub-Saharan Africa into an AIDS crisis and the epidemic is going to force a radical review of employee benefits, a life assurance expert said Monday.

"Our worst-case scenario is that we follow the rest of sub-Saharan Africa and I think we are on track to do that," Metropolitan Life senior general manager Peter Doyle told a conference of pension fund administrators.

He said the Department of Health's annual ante-natal survey indicated an average national HIV infection rate of 10.4 percent at the end of 1995, with a peak of 18.2 percent in KwaZulu-Natal province.

HIV is the virus that causes the deadly Acquired Immune Deficiency Syndrome (AIDS).

He said 10,000 AIDS cases had been reported by the end of last year, but his company estimated that the true figure probably was closer to 30,000.

"The epidemic is very well established and the prospect now is that it could reach higher levels in South Africa than it has in other African countries," Doyle said.

"By the year 2000, we could have in the order of 200,000 Aids cases in South Africa."

He said the nation's relatively sophisticated transport network contributed to the spread of the disease, which showed peak infection levels amongst people aged from 22 to 35.

Doyle said South African employers, insurers and labor unions would have to negotiate a response to the epidemic, which threatened to collapse the existing pension and employee benefit schemes.

"Whereas in the past, the bulk of benefit claims came later in life, with AIDS it comes plumb in the middle of the working years," he said, adding that proportion of insurance claims based on illness was rising in relation to deaths.

近年來雞尾酒療法的出現，為愛滋病患和醫學界帶來了一片希望，但誰也沒想到會再次踏上與DDT殺蟲劑一樣的宿命──抗藥性。

今年7月在巴黎舉行的國際愛滋病大會上，科學家發表了一份驚人的研究報告。在歐洲感染愛滋病的最新病例當中，有10％是感染帶抗藥性的變種病毒。一般而言，大多數病毒帶原者普遍採用「雞尾酒療法」，也就是服用3種藥劑的搭配療法。事實上，抗愛滋藥物已有17種，但總體可分為「核甘酸反轉錄脢抑制劑」、「非核甘酸反轉錄脢抑制劑」與「蛋白分解抑制劑」。

科學家表示，雞尾酒療法所使用這3種藥物大致都能控制病情，但是愛滋病病毒一旦對這3種藥物產生抗藥性，不只病患的免疫系統會遭到破壞，而且這些變種的病毒極可能具有更強大的生命力和威脅性。

在國際愛滋病大會上所公布的研究中，學者發現，變種病毒對某些藥品的抗藥性高得驚人。這項研究測試了來自17個歐洲國家1,633位經診斷帶有愛滋病毒、但還未接受治療的病人。有1.7％的病患對兩種以上的藥物具有抗藥性。而在美國舊金山市的病例報告也顯示，有超過1／4的病患帶有抗藥性。此外，專家也表示，不適當的服藥，是造成病毒產生抗藥性的主因。抗愛滋病藥品，應依照個人實際需求與用途開出處方，並且為藥物的使用提供正確的指導。為了解決當前的問題，科學家與藥商也積極研究發展能更有效阻擋病毒進入人體細胞的藥物。

反觀貧窮國家的愛滋病患，由於許多客觀環境問題的的存在，感染患者根本沒有能力支付龐大的醫療費用。以中國大陸為例，接受雞尾酒療程一年費用大約是9千至1萬5千美元左右（相當於一個中產階級的薪資）。而一個愛滋病患者接受病毒抗藥性的檢查，其費用也高達2百至8百美元。

基於這些因素，中國大陸最近傳出了許多傳統中醫療法，除了一些民間的草藥秘方，還有由中科院昆明植物研究所與泰國衛生部醫學科學廳所合作開發「AIDS中藥——複方SH」。普遍而言，西方藥廠所生產的抗愛滋藥品，其費用是貧窮國家患者所負擔不起的。儘管大量剽竊複製外國的藥品，中國國內的藥廠還是得生產非專利藥，供國內的愛滋病帶原者使用，根據聯合國估計，中國愛滋病帶原者人口有1百萬人。

今年的WTO會議中關切的一個議題是，要不要讓愛滋病流行的落後國家可以跳過取得藥廠專利的過程，自行生產抗愛滋病藥品？當歐美先進國家的愛滋病患正在煩惱抗藥性的問題，落後國家的愛滋病患卻在擔心哪來的錢吃藥？

One in 10 HIV patients in Europe newly infected with the virus that causes AIDS is infected with drug- resistant strains, researchers said on Wednesday.

Experts said the biggest study of its kind, presented at an international conference in Paris, showed the need for patients to adhere strictly to drug regimens and for companies to develop a constant stream of new medicines to keep AIDS at bay.

Resistance has long been viewed as a serious problem in AIDS hot spots such as San Francisco, where more than a quarter of patients are drug resistant, but the scale of the problem has not, until now, been monitored across such a large area.

David van de Vijver of University Medical Center Utrecht, Netherlands, said the scale of the problem in Europe was a concern.

"The conclusion of our study is that 10 percent of newly diagnosed patients in Europe are infected with a virus that contains resistance to at least one antiretroviral drug," he told reporters.

The study, conducted by Van de Vijver and colleagues and covering 1,633 patients from 17 European countries, also found that 1.7 percent of new patients were resistant to two or more antiretrovirals.

Non-adherence to drug treatment regimens is the main reason for the emergence of drug resistance. But Van de Vijver said its worrying spread in Europe also suggested many people on treatment were returning to high-risk behavior, such as engaging in unprotected sex and sharing hypodermic needles.

Joep Lange, president of the International AIDS Society, said drug resistance would never be eradicated because of the ability of HIV to mutate swiftly.

"That means we need to develop new drugs all the time and that also means that we need to keep research-based (pharmaceuticals companies) interested in HIV because if they are not interested any longer there will be a point of time when we are in a desperate situation," he said.

Lange rejected as "totally ridiculous" suggestions that the risk of resistance was a reason not to supply antiretrovirals to the developing world, where drug supplies and medical care may be less reliable.

Kevin Frost, director of the Treat Asia network working to roll out treatment in Asia, said the European study showed the need to get proper "triple therapy" treatments into poor countries.

"If we don't get it right we could be in for serious long-term problems in developing countries," he said.

There are currently 19 separate anti-HIV drugs on the market, falling into three main classes: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

Van de Vijver said resistance was found to the first class in 6.9 percent of the European patient group, resistance to the second class in 2.6 percent and resistance to protease inhibitors in 2.2 percent.

Researchers and pharmaceutical companies are working to develop a range of new medicines to attack the virus in novel ways.

These include several drugs designed to block HIV's entry into healthy cells. The first of these, a so-called fusion inhibitor called Fuzeon from Switzerland's Roche Holding AG and U.S. biotech Trimeris Inc., was recently launched in Europe and the United States. Other companies are also working on so-called integrase inhibitors, designed to block another step in the life cycle of HIV, although these are only at an early stage of development.

春季學期開始了。這個學期的自然科學課的主題是昆蟲。全班分成幾個組，分別研究不同昆蟲的繁衍過程、食物鏈和群體特徵，然後每人完成一個綜合報告。佳佳的題目是螞蟻。她興趣盎然，立刻從學校和當地社區圖書館的兒童部借來好幾本關於螞蟻的兒童科普讀物，認真閱讀，複印摘錄。

英國教育系統非常重視培養訓練孩子使用圖書館和博物館作為自己的主要學習資源。中小學有統一的教學大綱但沒有統一標準教材（當然，大學就更沒有了），因此學生必須從小學會使用圖書館和參考書。這樣的方式有助於激發孩子們主動地去學習知識，理解問題而不是被動機械地死記硬背標準答案。

無論個人喜好如何，佳佳能客觀評價老師的教學，而且她是很容易原諒人的。她告訴我們妮寇絲小姐的自然科學課上得很活、很好，孩子們都興致勃勃。那段時間，每當我們全家週末去海德公園散步，佳佳常會蹲在草地上久久地觀察螞蟻。我不得不對太太說，我們的女兒是不是瘋了。

的確，女兒一下變成了一個螞蟻專家，什麼工蟻、兵蟻、雄蟻、蟻后，講起來頭頭是道，把我這個博士震得目瞪口呆。女兒螞蟻瘋發了一個多月，終於製作出一本圖文並茂、充滿趣味的報告。封皮是精心設計的。螞蟻構成的花邊圖案中是由小螞蟻裝飾的大字彩色題目──ANTS（螞蟻）──和佳佳的名字。其下是一幅有趣的畫︰一隻肥大的蟻后對兩隻雄蟻說：「我滿肚子都是卵，太重了。」兩個雄蟻一個說：「哇，你看她多重呀」；另一個說：「哈，我們真幸運是不是？」

交報告的日子到了，佳佳信心十足，她相信她的報告是全班最好的。下午，佳佳垂頭喪氣地回到了家。我和太太都知道女兒又受了莫大的委屈，但這次她沒有哭，只是忿忿不平地把學校的事講給我們聽。

今天早上，佳佳和全班同學一起交上了報告，妮寇絲小姐非常高興，一邊瀏覽著一邊嘖嘖稱讚，這次全班的報告普遍的品質比較高。當她看到佳佳的報告時，停住了，仔細翻看了好一會兒。顯然這份報告的精美品質使她吃驚，可是她臉上剛才那種欣喜滿意的笑容卻因此而消失了。（待續）