保大人还是保小孩：我说了算！

If you live in a wealthy country, you have choices about your medical care.

如果深处富裕的国家，你可以对自己的医保进行选择。

Let's say you're a young woman who is HIV-positive and find out there's a new treatment that's much better for your long-term health.

打个比方说，假如你是一名检测出HIV阳性的年轻女士，发现有一种新药对你的长期健康更有益处。

But there's a potential problem: If you get pregnant, the drug could cause a serious birth defect in your baby.

但可能会存在一个问题：如果你怀孕了，这种药可能会引发婴儿的严重出生缺陷。

In the U.S., Europe and other wealthy areas, a doctor will explain the benefits and the risks.

在美国，欧洲及其他富裕地区，医生会解释清楚其益处和风险。

If you choose the new drug, the doctor will prescribe birth control.

如果你选择了这种新药，医生会开出避孕的处方。

If you want to get pregnant, the doctor will guide you through a period of taking the old drug, then get you back on the better drug when it no longer could endanger the fetus.

如果你想怀孕了，医生就会指导你先服用一段时间的旧药物，然后等对胎儿没有影响了再重新恢复使用新药。

Now, say you live in a poor country.

现在，又假设你处在一个贫穷的国家。

There aren't enough doctors and nurses to explain the risks and benefits of the new drug to every patient.

医护人员会比较短缺，无法向每一个人都解释清楚新药的利弊所在。

Your country may not have the resources to keep supplies of two different drugs on the shelves.

你的国家可能资源有限没法同时上架两种不同的药物。

And there is no consistent access to effective birth control.

而且有效的避孕药也并不能随时供应。

So what will those poor countries do in this kind of situation?

那这些贫穷的国家在这种情况下回怎么办呢？

Some will offer the new, better drug only to men and to women beyond child-bearing years.

有些国家会选择只给男士和过了生育年龄的女士提供新的，更好的药物。

Some won't offer the new drug at all.

有的国家则干脆不提供新药。

Many younger women will get the second-best treatment for AIDS simply because they're of child-bearing age.

很多更年轻的女士只能得到治疗艾滋的次好的药物，仅仅因为她们处于生育年龄。

That's the dilemma for many countries that don't have the resources to offer patients the same choices that people in rich countries have.

这就是很多资源不足，无法提供像富裕国家给患者的同样选择的国家所面临的困境。

The problem was explored in a new study released this month in the Annals of Internal Medicine.

有研究员就这个问题在发表于本月《内科年鉴》的一项研究中进行了探讨。

The new study was a response to a surprising result from a clinical trial comparing two AIDS treatments.

这项新研究对两种艾滋治疗药物的临床实验对比的意外结果进行了回应。

Between November 2016 and May 2018, 426 HIV-positive pregnant women in Botswana were given a new drug designed to treat their symptoms and help prevent HIV transmission to the baby and to the women's sex partners.

在2016年十一月到2018年五月之间，博茨瓦纳有426名HIV阳性的孕妇服用了一种新药物，这种药物专为治疗其症状并帮助防止HIV传染给孩子和性伴侣儿设计。

First reports from the clinical trial published in June 2018 in the Lancet showed that the new drug was, indeed, more effective than the old drug with fewer side effects.

这次临床实验的第一份报告于2018年六月发表在《柳叶刀》杂志上，表明这种新药实际上比旧药更有效，副作用也更少。

But as time went by and more babies were born, the researchers became alarmed about the drug's impact.

但随着时间的推移和更多宝宝的出生，研究员们开始对这种药的影响有所警觉。

Among the group of women who took the new drug during the period that they conceived the child, four of them gave birth to infants with severe brain defects.

在怀孕期间服用了这种药物的妇女中，有四人生下了患有严重脑缺陷的孩子。

In a flash, a promising international AIDS treatment strategy that was on the verge of being rolled out in sub-Saharan African countries was thrust into a world of uncertainty.

突然之间，人们本来打算把这种很有潜力的国际性的艾滋病治疗策略推广到撒哈拉以南非洲国家的，结果现在这种药物变得前途未卜。

The new study estimated what could happen if millions of poor HIV-positive African women of child-bearing age were given the new, more effective drug.

这次新研究进行了一种估算，就是如果上百万的贫穷的HIV阳性的生育年龄的非洲妇女服用了这种新的更有效的药物，会产生什么后果？

How many babies might be harmed?

以及会有多少孩子遭受伤害？

On the other hand, if the more effective drug were withheld, how many adult women would suffer health consequences?

另一方面，如果这种更有效的药物被下架了，又有多少成年的妇女会忍受病痛？

It has become a complicated equation, calling attention to a larger problem: How do very poor countries balance the health of women with the health of the babies they might bear?

这就变成了 一个复杂的方程式，让人们关注到另一个更大的问题：那些很贫穷的国家该如何在妇女和她们所怀的孩子的健康之间找到平衡？

Women are making it clear that they want control over their options for treatment.

非洲女士们明确表态，她们想要自己掌控对治疗的选择。

They know that it's likely that older men, not women of child-bearing age, are the people making decisions about which drug treatment will be available in their countries, Dugdale said.

她们知道，很可能那些更年长的男子，而不是生育年龄的女士会成为该国选择哪种药物治疗的决策者，道格戴尔说道。

They wrote a statement at the AIDS conference that said, in part: "We believe in our ability to make decisions about our reproductive health, including when to have children and what medications are best for us."

她们在国际艾滋大会上写下了一份声明，其写道：“我们相信自己有能力对自己的生育健康做出决定，包括什么时候该生，以及什么药物对我们最好。”

And they asked for improved access to birth control.

她们也要求要获得更好的避孕选择供应。

In other words, they want the same right to choose their treatment and their destiny as women in wealthy countries.

换句话说，她们要求跟富裕国家的女士一样享有同样的选择自己的治疗和命运的权利！

问题：

文中治疗艾滋说到的艾滋病新药要求人们在哪两者的健康之间做出抉择？

留意回复正确选项，前十名朋友可以获得红包奖励哦，快来试试吧！

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