{"version":"1.0.0","segments":[{"startTime":0.91,"endTime":3.78,"body":"- Today, I'm going to talk in this series"},{"startTime":3.78,"endTime":7.28,"body":"on different routes of"},{"startTime":3.78,"endTime":7.28,"body":"transmission of infection,"},{"startTime":7.28,"endTime":10.1,"body":"about sexually transmitted infections."},{"startTime":10.1,"endTime":12.83,"body":"And also those are passed on intravenously"},{"startTime":12.83,"endTime":15.183,"body":"or bloodborne infections."},{"startTime":16.74,"endTime":18.2,"body":"And this is part of a series"},{"startTime":18.2,"endTime":22.436,"body":"looking at the broadly five"},{"startTime":18.2,"endTime":22.436,"body":"routes by which we infections"},{"startTime":22.436,"endTime":25.33,"body":"are passed on between people"},{"startTime":25.33,"endTime":28.94,"body":"or occasionally between"},{"startTime":25.33,"endTime":28.94,"body":"animals and people."},{"startTime":28.94,"endTime":31.57,"body":"And the route of transmission in all cases"},{"startTime":31.57,"endTime":32.693,"body":"is really important"},{"startTime":32.693,"endTime":36.61,"body":"because it's key to understanding"},{"startTime":32.693,"endTime":36.61,"body":"how the disease behaves."},{"startTime":36.61,"endTime":39.823,"body":"And it's also key to"},{"startTime":36.61,"endTime":39.823,"body":"understanding how we control it."},{"startTime":40.8,"endTime":42.66,"body":"And the ones I've talked about already"},{"startTime":42.66,"endTime":44.8,"body":"are vector-borne diseases,"},{"startTime":44.8,"endTime":47.97,"body":"diseases passed on by"},{"startTime":44.8,"endTime":47.97,"body":"insects and arachnids,"},{"startTime":47.97,"endTime":51.97,"body":"oral diseases passed on by food and drink."},{"startTime":51.97,"endTime":55.79,"body":"And today I'm going to"},{"startTime":51.97,"endTime":55.79,"body":"talk about sexual diseases,"},{"startTime":55.79,"endTime":60.61,"body":"sexually transmitted infections"},{"startTime":55.79,"endTime":60.61,"body":"and bloodborne infections."},{"startTime":60.61,"endTime":62.84,"body":"Subsequently talk about"},{"startTime":60.61,"endTime":62.84,"body":"respiratory and touch,"},{"startTime":62.84,"endTime":65.623,"body":"which are the final ones in the group."},{"startTime":66.81,"endTime":69.73,"body":"Almost all infections"},{"startTime":66.81,"endTime":69.73,"body":"have a dominant route"},{"startTime":69.73,"endTime":71.87,"body":"by which they are mainly transmitted."},{"startTime":71.87,"endTime":73.08,"body":"Some of them it's exclusive."},{"startTime":73.08,"endTime":75.08,"body":"They only go by that route."},{"startTime":75.08,"endTime":77.86,"body":"Some of them have got a secondary"},{"startTime":75.08,"endTime":77.86,"body":"route and that's important"},{"startTime":77.86,"endTime":80.313,"body":"for some of the diseases"},{"startTime":77.86,"endTime":80.313,"body":"I'll talk about today."},{"startTime":84.07,"endTime":85.56,"body":"Now this is a big contrast"},{"startTime":85.56,"endTime":87.37,"body":"in terms of this route of transmission,"},{"startTime":87.37,"endTime":91.423,"body":"the sexual root, from the"},{"startTime":87.37,"endTime":91.423,"body":"ones I've talked about so far,"},{"startTime":92.33,"endTime":93.75,"body":"the previous things I've talked about"},{"startTime":93.75,"endTime":96.01,"body":"in this series can be passed on"},{"startTime":96.01,"endTime":98.97,"body":"between complete strangers,"},{"startTime":96.01,"endTime":98.97,"body":"often at a distance."},{"startTime":98.97,"endTime":101.87,"body":"So for example, an oral infection"},{"startTime":101.87,"endTime":104.56,"body":"could be passed on up the food chain."},{"startTime":104.56,"endTime":106.44,"body":"Passed on through a watercourse,"},{"startTime":106.44,"endTime":108.86,"body":"the vector-borne could be"},{"startTime":106.44,"endTime":108.86,"body":"passed on by a mosquito"},{"startTime":108.86,"endTime":111.403,"body":"flying from one village to another."},{"startTime":112.41,"endTime":115.36,"body":"In contrast, sexually"},{"startTime":112.41,"endTime":115.36,"body":"transmitted infections,"},{"startTime":115.36,"endTime":120.36,"body":"STIs are almost exclusively"},{"startTime":115.36,"endTime":120.36,"body":"transmitted by close contact."},{"startTime":121.46,"endTime":124.91,"body":"The two between two people"},{"startTime":121.46,"endTime":124.91,"body":"where the infecting person"},{"startTime":124.91,"endTime":128.94,"body":"knows the infected person very well."},{"startTime":128.94,"endTime":130.61,"body":"And usually is very fond of them,"},{"startTime":130.61,"endTime":132.43,"body":"loves them and cares deeply about them,"},{"startTime":132.43,"endTime":134.223,"body":"or at least desires them."},{"startTime":135.11,"endTime":138.143,"body":"So it's a very different"},{"startTime":135.11,"endTime":138.143,"body":"form of transmission."},{"startTime":139.25,"endTime":142.33,"body":"And because this is"},{"startTime":139.25,"endTime":142.33,"body":"something which is essential"},{"startTime":142.33,"endTime":143.56,"body":"for the survival of the species"},{"startTime":143.56,"endTime":145.478,"body":"and it's something which is happening"},{"startTime":145.478,"endTime":150.478,"body":"the whole time among"},{"startTime":145.478,"endTime":150.478,"body":"adults, several viruses,"},{"startTime":150.545,"endTime":152.43,"body":"bacteria, and parasites"},{"startTime":152.43,"endTime":155.77,"body":"have evolved to take advantage"},{"startTime":155.77,"endTime":159.13,"body":"of the strong human desire for intimacy,"},{"startTime":159.13,"endTime":162.193,"body":"for love and for sexual contact."},{"startTime":163.81,"endTime":166.56,"body":"It's a potentially from the"},{"startTime":163.81,"endTime":166.56,"body":"infection's point of view,"},{"startTime":166.56,"endTime":169.7,"body":"a very efficient transmission strategy."},{"startTime":169.7,"endTime":173.16,"body":"Two people are very close"},{"startTime":169.7,"endTime":173.16,"body":"together for prolonged periods,"},{"startTime":173.16,"endTime":177.25,"body":"often not taking huge amounts of care"},{"startTime":177.25,"endTime":179.38,"body":"because they have other"},{"startTime":177.25,"endTime":179.38,"body":"things on their minds."},{"startTime":179.38,"endTime":183.78,"body":"And it's also often a"},{"startTime":179.38,"endTime":183.78,"body":"relatively less defended parts"},{"startTime":183.78,"endTime":185.33,"body":"of the body, immunologically,"},{"startTime":185.33,"endTime":187.65,"body":"the skin for example, very tough,"},{"startTime":187.65,"endTime":188.94,"body":"very few things and get through it."},{"startTime":188.94,"endTime":191.3,"body":"I'll come onto that in a later lecture,"},{"startTime":191.3,"endTime":192.79,"body":"the gut which we've talked about,"},{"startTime":192.79,"endTime":195.64,"body":"hugely defended by"},{"startTime":192.79,"endTime":195.64,"body":"multiple layers defects,"},{"startTime":195.64,"endTime":199.61,"body":"less so for sexually"},{"startTime":195.64,"endTime":199.61,"body":"transmitted infections."},{"startTime":199.61,"endTime":204.19,"body":"And this can happen in all"},{"startTime":199.61,"endTime":204.19,"body":"forms of sexual contact,"},{"startTime":204.19,"endTime":208.445,"body":"heterosexual men having"},{"startTime":204.19,"endTime":208.445,"body":"sex with men and women,"},{"startTime":208.445,"endTime":209.53,"body":"having sex with women,"},{"startTime":208.445,"endTime":209.53,"body":"all of these are possible,"},{"startTime":209.53,"endTime":212.283,"body":"but different ratios,"},{"startTime":209.53,"endTime":212.283,"body":"which I'll come on to."},{"startTime":215.643,"endTime":220.31,"body":"It's often assumed and wrongly,"},{"startTime":220.31,"endTime":223.68,"body":"that SDIs are magically trivial."},{"startTime":223.68,"endTime":228.34,"body":"And some of them are, but"},{"startTime":223.68,"endTime":228.34,"body":"several of the major diseases"},{"startTime":228.34,"endTime":231.02,"body":"of humanity both now, and historically"},{"startTime":231.02,"endTime":234.838,"body":"are transmitted mainly or exclusively"},{"startTime":234.838,"endTime":236.523,"body":"via the sexual route."},{"startTime":237.36,"endTime":239.94,"body":"These include, and I'll go into these"},{"startTime":239.94,"endTime":242.12,"body":"in greater detail, HIV,"},{"startTime":242.12,"endTime":244.62,"body":"which is the last really serious pandemic"},{"startTime":244.62,"endTime":247.8,"body":"we had before COVID and has killed"},{"startTime":247.8,"endTime":250.79,"body":"over 36 million people to date."},{"startTime":250.79,"endTime":254.02,"body":"According to WHO statistics, syphilis,"},{"startTime":254.02,"endTime":256.96,"body":"a major multi-system disease, again,"},{"startTime":256.96,"endTime":260.58,"body":"caused huge epidemics"},{"startTime":256.96,"endTime":260.58,"body":"when it first arrived,"},{"startTime":260.58,"endTime":265.58,"body":"several infections that cause"},{"startTime":260.58,"endTime":265.58,"body":"cancer, including a HPV,"},{"startTime":267.28,"endTime":269.593,"body":"which causes cervical cancer, hepatitis B."},{"startTime":270.563,"endTime":273.27,"body":"Again, I'll go into"},{"startTime":270.563,"endTime":273.27,"body":"those in greater detail"},{"startTime":273.27,"endTime":275.53,"body":"and then many more classical"},{"startTime":275.53,"endTime":277.48,"body":"sexually transmitted infections,"},{"startTime":277.48,"endTime":280.32,"body":"which can cause significant"},{"startTime":277.48,"endTime":280.32,"body":"physical problems,"},{"startTime":280.32,"endTime":284.04,"body":"including infertility,"},{"startTime":280.32,"endTime":284.04,"body":"particularly in women,"},{"startTime":284.04,"endTime":289.04,"body":"but in both genders,"},{"startTime":284.04,"endTime":289.04,"body":"stillbirth and other problems"},{"startTime":290.5,"endTime":294.653,"body":"in the course of a pregnancy"},{"startTime":290.5,"endTime":294.653,"body":"and neonatal damage."},{"startTime":295.7,"endTime":298.47,"body":"And they can also cause significant stress"},{"startTime":298.47,"endTime":300.44,"body":"and relationship damage."},{"startTime":300.44,"endTime":303.293,"body":"So these are not trivial"},{"startTime":300.44,"endTime":303.293,"body":"infections by any means."},{"startTime":308.11,"endTime":311.03,"body":"Now because the route of transmission"},{"startTime":311.03,"endTime":314.27,"body":"between the two people is so short"},{"startTime":314.27,"endTime":317.18,"body":"because people are basically"},{"startTime":314.27,"endTime":317.18,"body":"against one another"},{"startTime":317.18,"endTime":320.45,"body":"for a very significant period of time."},{"startTime":320.45,"endTime":323.18,"body":"The ability medically to intervene"},{"startTime":323.18,"endTime":326.67,"body":"is very different from other"},{"startTime":323.18,"endTime":326.67,"body":"routes of transmission."},{"startTime":326.67,"endTime":330.92,"body":"So if you think about the"},{"startTime":326.67,"endTime":330.92,"body":"vector-borne diseases,"},{"startTime":330.92,"endTime":333.39,"body":"if you can intervene with the insect"},{"startTime":333.39,"endTime":335.0,"body":"that is carrying the disease"},{"startTime":335.0,"endTime":337.02,"body":"between one person and the next,"},{"startTime":337.02,"endTime":338.42,"body":"you can stop the transmission."},{"startTime":338.42,"endTime":341.22,"body":"If you think about the"},{"startTime":338.42,"endTime":341.22,"body":"waterborne diseases,"},{"startTime":341.22,"endTime":343.55,"body":"if you can keep feces out of water,"},{"startTime":343.55,"endTime":346.2,"body":"if you can have proper sewage disposal,"},{"startTime":346.2,"endTime":350.55,"body":"proper clean water, you can, for example,"},{"startTime":350.55,"endTime":353.959,"body":"reduce or remove completely"},{"startTime":350.55,"endTime":353.959,"body":"the risk of infection"},{"startTime":353.959,"endTime":354.94,"body":"there can be a medical intervention"},{"startTime":354.94,"endTime":358.29,"body":"between the infected person and the person"},{"startTime":358.29,"endTime":360.67,"body":"who becomes infected subsequently."},{"startTime":360.67,"endTime":362.14,"body":"For sexually transmitted infections,"},{"startTime":362.14,"endTime":363.38,"body":"of course you can't,"},{"startTime":363.38,"endTime":366.55,"body":"the contact is direct and it is personal."},{"startTime":366.55,"endTime":371.55,"body":"So there's much greater Alliance"},{"startTime":366.55,"endTime":371.55,"body":"medically on finding cases"},{"startTime":371.86,"endTime":375.8,"body":"amongst people who are infected early on"},{"startTime":375.8,"endTime":378.63,"body":"in their disease and treating them."},{"startTime":378.63,"endTime":381.1,"body":"And if they're in a stable partnership"},{"startTime":381.1,"endTime":383.89,"body":"or have had recent sexual partners,"},{"startTime":383.89,"endTime":385.23,"body":"who can be contact traced,"},{"startTime":385.23,"endTime":388.063,"body":"treating their contacts at the same time."},{"startTime":389.91,"endTime":392.94,"body":"Now, one of the biggest barriers"},{"startTime":389.91,"endTime":392.94,"body":"to being able to do this"},{"startTime":392.94,"endTime":396.58,"body":"is embarrassment or shame,"},{"startTime":396.58,"endTime":399.55,"body":"where someone feels"},{"startTime":396.58,"endTime":399.55,"body":"embarrassed about the fact"},{"startTime":399.55,"endTime":401.67,"body":"they have a sexually"},{"startTime":399.55,"endTime":401.67,"body":"transmitted infection."},{"startTime":401.67,"endTime":403.87,"body":"And this is often the reason"},{"startTime":401.67,"endTime":403.87,"body":"people don't seek help"},{"startTime":403.87,"endTime":406.78,"body":"or don't seek help early enough."},{"startTime":406.78,"endTime":409.54,"body":"And I think I cannot stress too strongly"},{"startTime":409.54,"endTime":411.24,"body":"that for all medical staff,"},{"startTime":411.24,"endTime":416.19,"body":"nursing staff and others,"},{"startTime":411.24,"endTime":416.19,"body":"diagnosing and treating SDIs"},{"startTime":416.19,"endTime":418.13,"body":"is common and normal business."},{"startTime":418.13,"endTime":419.605,"body":"These are common diseases."},{"startTime":419.605,"endTime":422.07,"body":"They're things people"},{"startTime":419.605,"endTime":422.07,"body":"get and they're things"},{"startTime":422.07,"endTime":424.953,"body":"which can almost in all cases be treated."},{"startTime":426.35,"endTime":429.54,"body":"So stigma is a very major barrier"},{"startTime":429.54,"endTime":433.37,"body":"to diagnosing and treating"},{"startTime":429.54,"endTime":433.37,"body":"STIs and recognizing this,"},{"startTime":433.37,"endTime":434.51,"body":"there are several different routes"},{"startTime":434.51,"endTime":437.75,"body":"by which people can seek treatment."},{"startTime":437.75,"endTime":439.88,"body":"Obviously people go can go to their GPS"},{"startTime":439.88,"endTime":441.66,"body":"and through those kinds of routes,"},{"startTime":441.66,"endTime":446.31,"body":"there are also separately"},{"startTime":441.66,"endTime":446.31,"body":"and entirely confidentially,"},{"startTime":446.31,"endTime":448.12,"body":"sexually transmitted infection clinics"},{"startTime":448.12,"endTime":449.8,"body":"which specialize in this area"},{"startTime":449.8,"endTime":451.82,"body":"and keep completely confidential records"},{"startTime":451.82,"endTime":453.18,"body":"separate from other ones."},{"startTime":453.18,"endTime":456.423,"body":"So there are various ways"},{"startTime":453.18,"endTime":456.423,"body":"people can access care."},{"startTime":458.81,"endTime":461.72,"body":"Medical interventions can"},{"startTime":458.81,"endTime":461.72,"body":"also include behavior change,"},{"startTime":461.72,"endTime":466.72,"body":"and this is possible, but"},{"startTime":461.72,"endTime":466.72,"body":"people have to engage with it."},{"startTime":467.08,"endTime":468.91,"body":"And it includes things like using condoms,"},{"startTime":468.91,"endTime":470.91,"body":"which we'll come back to."},{"startTime":470.91,"endTime":472.84,"body":"Now, there are some important"},{"startTime":472.84,"endTime":474.57,"body":"sexually transmitted infections"},{"startTime":474.57,"endTime":478.65,"body":"for which we now have"},{"startTime":474.57,"endTime":478.65,"body":"vaccines, but for most of them,"},{"startTime":478.65,"endTime":482.35,"body":"the main stay of management is treatment."},{"startTime":482.35,"endTime":485.28,"body":"And that of course means"},{"startTime":482.35,"endTime":485.28,"body":"you've got to diagnose it"},{"startTime":485.28,"endTime":488.05,"body":"before you treat it, so unlike a vaccine,"},{"startTime":488.05,"endTime":489.574,"body":"which you just give to everybody,"},{"startTime":489.574,"endTime":491.827,"body":"the treatment will only be given to people"},{"startTime":491.827,"endTime":494.323,"body":"who are infected, so people"},{"startTime":491.827,"endTime":494.323,"body":"have got to be identified."},{"startTime":497.89,"endTime":501.17,"body":"Unsurprisingly, STIs are mainly diseases"},{"startTime":501.17,"endTime":504.19,"body":"of sexually active adults."},{"startTime":504.19,"endTime":507.26,"body":"So most infectious diseases,"},{"startTime":504.19,"endTime":507.26,"body":"if you think about them,"},{"startTime":507.26,"endTime":510.58,"body":"have their biggest"},{"startTime":507.26,"endTime":510.58,"body":"impacts in the very young"},{"startTime":510.58,"endTime":514.92,"body":"and in the relatively or very old."},{"startTime":514.92,"endTime":517.05,"body":"And if you think about COVID,"},{"startTime":517.05,"endTime":518.61,"body":"which we're going through at the moment,"},{"startTime":518.61,"endTime":522.19,"body":"really heavy burden has"},{"startTime":518.61,"endTime":522.19,"body":"fallen on older people"},{"startTime":522.19,"endTime":523.74,"body":"because of the higher risk of that age."},{"startTime":523.74,"endTime":524.72,"body":"But for many infections,"},{"startTime":524.72,"endTime":528.24,"body":"it's the very young and the"},{"startTime":524.72,"endTime":528.24,"body":"very old who are most effected."},{"startTime":528.24,"endTime":530.602,"body":"SDIs are in a sense, the"},{"startTime":528.24,"endTime":530.602,"body":"complete opposite of that."},{"startTime":530.602,"endTime":535.602,"body":"They occur if they do"},{"startTime":530.602,"endTime":535.602,"body":"occur after sexual debue."},{"startTime":537.14,"endTime":539.52,"body":"And so therefore they're"},{"startTime":537.14,"endTime":539.52,"body":"usually diseases of adults"},{"startTime":539.52,"endTime":542.88,"body":"and specifically they're"},{"startTime":539.52,"endTime":542.88,"body":"most commonly acquired"},{"startTime":542.88,"endTime":545.52,"body":"early on in people's sexual lives,"},{"startTime":545.52,"endTime":548.453,"body":"before they have formed"},{"startTime":545.52,"endTime":548.453,"body":"their lifelong partnerships."},{"startTime":549.74,"endTime":552.6,"body":"And therefore, they tend"},{"startTime":549.74,"endTime":552.6,"body":"to be heavily weighted"},{"startTime":552.6,"endTime":554.17,"body":"towards a younger adults,"},{"startTime":554.17,"endTime":555.873,"body":"very different age spectrum."},{"startTime":557.52,"endTime":558.61,"body":"It's important to understand though"},{"startTime":558.61,"endTime":561.9,"body":"that many can be, if untreated,"},{"startTime":561.9,"endTime":564.23,"body":"and many people don't know"},{"startTime":561.9,"endTime":564.23,"body":"they're carrying them,"},{"startTime":564.23,"endTime":566.17,"body":"they can remain infectious for years"},{"startTime":566.17,"endTime":568.48,"body":"and in some cases for life."},{"startTime":568.48,"endTime":570.83,"body":"So if someone does get"},{"startTime":568.48,"endTime":570.83,"body":"infected in young adulthood,"},{"startTime":570.83,"endTime":572.82,"body":"they could carry that infection"},{"startTime":572.82,"endTime":575.5,"body":"with them for years or decades."},{"startTime":575.5,"endTime":578.65,"body":"And people are often"},{"startTime":575.5,"endTime":578.65,"body":"unaware they've got them,"},{"startTime":578.65,"endTime":580.69,"body":"have no symptoms themselves."},{"startTime":580.69,"endTime":583.08,"body":"And the first time they'd"},{"startTime":580.69,"endTime":583.08,"body":"realized they've acquired"},{"startTime":583.08,"endTime":585.68,"body":"at some point along their sexual life,"},{"startTime":585.68,"endTime":587.29,"body":"a sexually transmitted infection"},{"startTime":587.29,"endTime":590.527,"body":"is when a new sexual partner"},{"startTime":590.527,"endTime":594.61,"body":"develops the infection and get symptoms."},{"startTime":594.61,"endTime":596.68,"body":"And this could be many years"},{"startTime":596.68,"endTime":599.66,"body":"after the last sexual"},{"startTime":596.68,"endTime":599.66,"body":"relationship they had,"},{"startTime":599.66,"endTime":601.53,"body":"but because the disease has stayed there"},{"startTime":601.53,"endTime":605.257,"body":"and without symptoms,"},{"startTime":601.53,"endTime":605.257,"body":"people just are not aware"},{"startTime":605.257,"endTime":606.09,"body":"of the fact they've got it"},{"startTime":606.09,"endTime":607.303,"body":"until as I say, they pass it on."},{"startTime":610.82,"endTime":613.92,"body":"Just to put a little bit"},{"startTime":610.82,"endTime":613.92,"body":"of a few numbers on this,"},{"startTime":613.92,"endTime":618.45,"body":"this is the rate of new STI"},{"startTime":613.92,"endTime":618.45,"body":"diagnosis by gender and age."},{"startTime":618.45,"endTime":621.55,"body":"And there is a bit of a"},{"startTime":618.45,"endTime":621.55,"body":"difference between the genders,"},{"startTime":621.55,"endTime":623.15,"body":"in England in 2019,"},{"startTime":623.15,"endTime":625.64,"body":"this is the year before obviously COVID"},{"startTime":625.64,"endTime":628.95,"body":"started to change the"},{"startTime":625.64,"endTime":628.95,"body":"statistics provided reasons."},{"startTime":628.95,"endTime":631.53,"body":"And what you can see is the youngest,"},{"startTime":631.53,"endTime":633.52,"body":"15 to 19 are the Boston bars."},{"startTime":633.52,"endTime":637.58,"body":"And they go right up to people"},{"startTime":633.52,"endTime":637.58,"body":"in the sixties at the top,"},{"startTime":637.58,"endTime":639.73,"body":"STIs can happen to any"},{"startTime":637.58,"endTime":639.73,"body":"stage on the life course,"},{"startTime":639.73,"endTime":642.53,"body":"but a really heavy concentration,"},{"startTime":642.53,"endTime":645.13,"body":"particularly in people in"},{"startTime":642.53,"endTime":645.13,"body":"the early and mid twenties"},{"startTime":646.388,"endTime":647.971,"body":"and early thirties."},{"startTime":650.82,"endTime":653.9,"body":"An important part of STIs"},{"startTime":650.82,"endTime":653.9,"body":"particularly to pull out"},{"startTime":653.9,"endTime":658.9,"body":"I think is the impact on"},{"startTime":653.9,"endTime":658.9,"body":"pregnancy and on childbirth."},{"startTime":659.66,"endTime":662.23,"body":"And it's really very"},{"startTime":659.66,"endTime":662.23,"body":"important to identify STIs"},{"startTime":662.23,"endTime":664.19,"body":"if someone has got them,"},{"startTime":664.19,"endTime":666.41,"body":"ideally before they become pregnant."},{"startTime":666.41,"endTime":671.393,"body":"And certainly before later"},{"startTime":666.41,"endTime":671.393,"body":"stages of pregnancy and labor."},{"startTime":673.0,"endTime":675.89,"body":"Some major STIs can be passed vertically"},{"startTime":675.89,"endTime":680.04,"body":"from mother to baby, including HIV,"},{"startTime":680.04,"endTime":683.53,"body":"syphilis, and hepatitis B,"},{"startTime":680.04,"endTime":683.53,"body":"all of which I'll talk about"},{"startTime":683.53,"endTime":685.503,"body":"in a bit more detail in a minute."},{"startTime":686.87,"endTime":688.705,"body":"Some of them can be passed on to the baby"},{"startTime":688.705,"endTime":692.16,"body":"in the birth canal during labor."},{"startTime":692.16,"endTime":695.56,"body":"So as the baby comes out,"},{"startTime":692.16,"endTime":695.56,"body":"and they can cover the baby,"},{"startTime":695.56,"endTime":698.44,"body":"get on the baby or into their eyes"},{"startTime":698.44,"endTime":700.67,"body":"and cause significant issues"},{"startTime":700.67,"endTime":703.653,"body":"for the neonatal baby when it comes out."},{"startTime":704.55,"endTime":706.88,"body":"So therefore checking for STI,"},{"startTime":706.88,"endTime":708.51,"body":"remembering that these are common"},{"startTime":708.51,"endTime":712.28,"body":"and treating them before"},{"startTime":708.51,"endTime":712.28,"body":"or early on in pregnancy"},{"startTime":712.28,"endTime":714.933,"body":"should be seen as normal, good care."},{"startTime":716.58,"endTime":720.783,"body":"By definition, a woman who is"},{"startTime":716.58,"endTime":720.783,"body":"pregnant is actually active."},{"startTime":725.84,"endTime":727.79,"body":"Now it may seem slightly odd"},{"startTime":727.79,"endTime":729.62,"body":"that I put bloodborne infections"},{"startTime":729.62,"endTime":731.94,"body":"alongside sexually transmitted infections."},{"startTime":731.94,"endTime":733.81,"body":"But the reason for doing that"},{"startTime":733.81,"endTime":737.37,"body":"is that for the most important"},{"startTime":733.81,"endTime":737.37,"body":"bloodborne infections,"},{"startTime":737.37,"endTime":739.21,"body":"the ones that are primarily or largely"},{"startTime":739.21,"endTime":743.75,"body":"or partially transmitted"},{"startTime":739.21,"endTime":743.75,"body":"by blood to blood contact"},{"startTime":743.75,"endTime":746.3,"body":"are also sexually transmitted."},{"startTime":746.3,"endTime":747.45,"body":"So they're the same infection,"},{"startTime":747.45,"endTime":748.803,"body":"but by different routes."},{"startTime":750.12,"endTime":753.31,"body":"And historically, medical practice"},{"startTime":753.31,"endTime":754.97,"body":"was an important way that"},{"startTime":754.97,"endTime":759.05,"body":"some of these were passed"},{"startTime":754.97,"endTime":759.05,"body":"on classically, for example,"},{"startTime":759.05,"endTime":762.47,"body":"using the same needle to"},{"startTime":759.05,"endTime":762.47,"body":"inject several different people"},{"startTime":762.47,"endTime":764.53,"body":"or using an improperly cleaned"},{"startTime":764.53,"endTime":768.42,"body":"or sterilized knife or scalpel in surgery,"},{"startTime":768.42,"endTime":770.55,"body":"or indeed in traditional medical practice,"},{"startTime":770.55,"endTime":772.32,"body":"scarification and things like that,"},{"startTime":772.32,"endTime":776.511,"body":"where the same object would be"},{"startTime":772.32,"endTime":776.511,"body":"used on two different people,"},{"startTime":776.511,"endTime":778.88,"body":"transmitting blood from one to the second,"},{"startTime":778.88,"endTime":779.94,"body":"relatively small amounts,"},{"startTime":779.94,"endTime":781.703,"body":"but enough to pass on an infection."},{"startTime":783.75,"endTime":786.36,"body":"That's obviously gone right down."},{"startTime":786.36,"endTime":788.68,"body":"People now use in medical practice,"},{"startTime":788.68,"endTime":790.99,"body":"almost exclusively reusable"},{"startTime":790.99,"endTime":794.383,"body":"or very heavily sterilized objects."},{"startTime":795.86,"endTime":798.53,"body":"The second medical way"},{"startTime":795.86,"endTime":798.53,"body":"this was transmitted,"},{"startTime":798.53,"endTime":801.83,"body":"and there were some very"},{"startTime":798.53,"endTime":801.83,"body":"tragic examples of this"},{"startTime":801.83,"endTime":805.19,"body":"where blood products before"},{"startTime":801.83,"endTime":805.19,"body":"there was effective screening."},{"startTime":805.19,"endTime":808.58,"body":"And in particular, this"},{"startTime":805.19,"endTime":808.58,"body":"was important for HIV,"},{"startTime":808.58,"endTime":811.243,"body":"for hepatitis B and hepatitis C."},{"startTime":813.03,"endTime":816.5,"body":"The third group, again,"},{"startTime":813.03,"endTime":816.5,"body":"that's been largely eliminated"},{"startTime":816.5,"endTime":818.4,"body":"by screening methods."},{"startTime":818.4,"endTime":820.52,"body":"The third group where infections"},{"startTime":820.52,"endTime":822.39,"body":"are passed on blood to blood."},{"startTime":822.39,"endTime":824.76,"body":"So from one person's blood"},{"startTime":822.39,"endTime":824.76,"body":"directly to the others,"},{"startTime":824.76,"endTime":827.67,"body":"usually by a syringe is people"},{"startTime":827.67,"endTime":829.45,"body":"who are intravenous drug users"},{"startTime":829.45,"endTime":831.88,"body":"who share needles and syringes."},{"startTime":831.88,"endTime":834.31,"body":"And this used to be very common practice"},{"startTime":834.31,"endTime":836.38,"body":"in many places and still"},{"startTime":834.31,"endTime":836.38,"body":"is very common practice"},{"startTime":836.38,"endTime":838.27,"body":"in many parts of the world."},{"startTime":838.27,"endTime":843.27,"body":"And this can pass on many"},{"startTime":838.27,"endTime":843.27,"body":"major bloodborne infections,"},{"startTime":843.77,"endTime":847.66,"body":"including HIV, hepatitis"},{"startTime":843.77,"endTime":847.66,"body":"B and hepatitis C."},{"startTime":847.66,"endTime":850.81,"body":"There are others, but those"},{"startTime":847.66,"endTime":850.81,"body":"are particularly important."},{"startTime":850.81,"endTime":852.54,"body":"And there are a variety"},{"startTime":850.81,"endTime":852.54,"body":"of ways which these"},{"startTime":852.54,"endTime":854.26,"body":"can be addressed."},{"startTime":854.26,"endTime":856.37,"body":"For example, using needle exchanges"},{"startTime":856.37,"endTime":859.49,"body":"to encourage people always"},{"startTime":856.37,"endTime":859.49,"body":"to use clean needles"},{"startTime":859.49,"endTime":862.603,"body":"keep a needle at least"},{"startTime":859.49,"endTime":862.603,"body":"exclusive to themselves."},{"startTime":867.01,"endTime":869.91,"body":"I think it is worth just"},{"startTime":867.01,"endTime":869.91,"body":"pausing on the issue"},{"startTime":869.91,"endTime":871.98,"body":"of blood transfusions and blood products."},{"startTime":871.98,"endTime":873.23,"body":"Things like factor eight,"},{"startTime":874.31,"endTime":878.04,"body":"these are an extraordinary"},{"startTime":874.31,"endTime":878.04,"body":"gift from one person to another"},{"startTime":878.04,"endTime":879.65,"body":"they usually don't know at all."},{"startTime":879.65,"endTime":883.5,"body":"People who donate blood"},{"startTime":879.65,"endTime":883.5,"body":"are extremely altruistic"},{"startTime":883.5,"endTime":887.38,"body":"and the health service"},{"startTime":883.5,"endTime":887.38,"body":"and people's ability"},{"startTime":887.38,"endTime":891.22,"body":"to have operations and to"},{"startTime":887.38,"endTime":891.22,"body":"recover from major traumas"},{"startTime":891.22,"endTime":893.81,"body":"and things depend on"},{"startTime":891.22,"endTime":893.81,"body":"people being altruistic."},{"startTime":893.81,"endTime":898.81,"body":"So they can be lifesaving,"},{"startTime":893.81,"endTime":898.81,"body":"but if not properly managed,"},{"startTime":898.88,"endTime":901.95,"body":"they can also transmit infections."},{"startTime":901.95,"endTime":904.35,"body":"And the way that blood is managed"},{"startTime":904.35,"endTime":905.87,"body":"between the person who donates it"},{"startTime":905.87,"endTime":910.71,"body":"and the person who receives"},{"startTime":905.87,"endTime":910.71,"body":"it is it's done to minimize"},{"startTime":910.71,"endTime":912.66,"body":"the chance that any infection"},{"startTime":912.66,"endTime":915.4,"body":"can be passed on by this route."},{"startTime":915.4,"endTime":917.33,"body":"This includes things like saying,"},{"startTime":917.33,"endTime":919.57,"body":"please don't give blood if"},{"startTime":917.33,"endTime":919.57,"body":"you're unwell at this moment,"},{"startTime":919.57,"endTime":921.54,"body":"if you've got an infection,"},{"startTime":919.57,"endTime":921.54,"body":"if you've got fever,"},{"startTime":921.54,"endTime":923.59,"body":"some travel destinations, so for example,"},{"startTime":923.59,"endTime":925.77,"body":"if someone's gone to a"},{"startTime":923.59,"endTime":925.77,"body":"place where there's malaria,"},{"startTime":925.77,"endTime":927.69,"body":"malaria can be passed on blood to blood,"},{"startTime":927.69,"endTime":931.21,"body":"mainly passed, almost entirely"},{"startTime":927.69,"endTime":931.21,"body":"passed on via mosquitoes,"},{"startTime":931.21,"endTime":933.84,"body":"but can be passed on"},{"startTime":931.21,"endTime":933.84,"body":"by blood transfusions,"},{"startTime":933.84,"endTime":938.38,"body":"very rarely, but the"},{"startTime":933.84,"endTime":938.38,"body":"important blood infections,"},{"startTime":938.38,"endTime":941.89,"body":"which can be passed on"},{"startTime":938.38,"endTime":941.89,"body":"without careful management"},{"startTime":941.89,"endTime":945.83,"body":"include HIV, hepatitis B and C."},{"startTime":945.83,"endTime":947.33,"body":"And these have to be screened for,"},{"startTime":947.33,"endTime":949.58,"body":"people obviously are excluded"},{"startTime":949.58,"endTime":951.11,"body":"if they know they've got disease,"},{"startTime":951.11,"endTime":954.53,"body":"but they also have to be"},{"startTime":951.11,"endTime":954.53,"body":"screened for afterwards."},{"startTime":954.53,"endTime":956.2,"body":"And the infection rate by this route"},{"startTime":956.2,"endTime":958.823,"body":"is now very low indeed."},{"startTime":963.27,"endTime":966.96,"body":"Now I'd like to move on to some"},{"startTime":963.27,"endTime":966.96,"body":"of the important infections"},{"startTime":966.96,"endTime":969.47,"body":"that are worth thinking through,"},{"startTime":969.47,"endTime":971.21,"body":"and really mainly concentrating"},{"startTime":971.21,"endTime":972.99,"body":"on the sexually transmitted infections."},{"startTime":972.99,"endTime":976.163,"body":"And the first of these I'd"},{"startTime":972.99,"endTime":976.163,"body":"like to talk about is syphilis."},{"startTime":977.36,"endTime":980.24,"body":"Syphilis was a new disease in Europe,"},{"startTime":980.24,"endTime":982.22,"body":"or we think it was probably a new disease"},{"startTime":982.22,"endTime":984.24,"body":"in Europe in the 1490s,"},{"startTime":984.24,"endTime":986.87,"body":"lots of different views"},{"startTime":984.24,"endTime":986.87,"body":"about where it came from."},{"startTime":986.87,"endTime":989.05,"body":"Did it come over with Columbus or so on?"},{"startTime":989.05,"endTime":990.81,"body":"What certainly happened is it got spread"},{"startTime":990.81,"endTime":993.99,"body":"following the Siege of Naples."},{"startTime":993.99,"endTime":996.33,"body":"And it's spread over a"},{"startTime":993.99,"endTime":996.33,"body":"very small number of years"},{"startTime":996.33,"endTime":999.01,"body":"in the 1490s and swept through Europe"},{"startTime":999.01,"endTime":1001.14,"body":"over a small number of years."},{"startTime":1001.14,"endTime":1002.73,"body":"Probably it was more severe"},{"startTime":1002.73,"endTime":1005.38,"body":"early in its waves then subsequently,"},{"startTime":1005.38,"endTime":1009.293,"body":"but it was and indeed still"},{"startTime":1005.38,"endTime":1009.293,"body":"remains a serious disease."},{"startTime":1010.57,"endTime":1014.37,"body":"It was really realized fairly"},{"startTime":1010.57,"endTime":1014.37,"body":"early on in this new epidemic,"},{"startTime":1014.37,"endTime":1017.22,"body":"this frightening epidemic"},{"startTime":1014.37,"endTime":1017.22,"body":"that spread through Europe,"},{"startTime":1017.22,"endTime":1019.24,"body":"that it was sexually transmitted"},{"startTime":1019.24,"endTime":1021.92,"body":"and as has happened very often,"},{"startTime":1021.92,"endTime":1024.23,"body":"this was therefore very quickly blamed"},{"startTime":1024.23,"endTime":1029.23,"body":"on foreigners, in England"},{"startTime":1024.23,"endTime":1029.23,"body":"and UK more widely,"},{"startTime":1029.5,"endTime":1032.43,"body":"it was known as the French"},{"startTime":1029.5,"endTime":1032.43,"body":"disease elsewhere in Europe"},{"startTime":1032.43,"endTime":1034.38,"body":"it's known as the Italian"},{"startTime":1032.43,"endTime":1034.38,"body":"or Spanish disease,"},{"startTime":1034.38,"endTime":1036.86,"body":"Russia, it was known as the"},{"startTime":1034.38,"endTime":1036.86,"body":"Polish disease and so on,"},{"startTime":1036.86,"endTime":1038.96,"body":"but I think there's a theme emerging here,"},{"startTime":1039.8,"endTime":1042.5,"body":"but it was actually a"},{"startTime":1039.8,"endTime":1042.5,"body":"disease that was passed on"},{"startTime":1042.5,"endTime":1046.703,"body":"in every country in the continent."},{"startTime":1047.94,"endTime":1051.46,"body":"As a disease which was both dangerous,"},{"startTime":1051.46,"endTime":1053.7,"body":"caused serious illness, also"},{"startTime":1051.46,"endTime":1053.7,"body":"caused the visible scars"},{"startTime":1053.7,"endTime":1056.61,"body":"that people you could see very often"},{"startTime":1056.61,"endTime":1059.02,"body":"who'd had syphilis or been treated for it"},{"startTime":1059.02,"endTime":1062.6,"body":"due to some of the scarring it caused."},{"startTime":1062.6,"endTime":1064.59,"body":"And the stigma that went with it,"},{"startTime":1064.59,"endTime":1065.97,"body":"particularly associated with the fact"},{"startTime":1065.97,"endTime":1067.23,"body":"that it was sexually"},{"startTime":1065.97,"endTime":1067.23,"body":"transmitted initially,"},{"startTime":1067.23,"endTime":1069.27,"body":"and the feeling that this was associated,"},{"startTime":1069.27,"endTime":1073.05,"body":"with kind of moral laxness,"},{"startTime":1073.05,"endTime":1077.52,"body":"it was very widely feared and"},{"startTime":1073.05,"endTime":1077.52,"body":"it had a very profound effect"},{"startTime":1077.52,"endTime":1079.613,"body":"on the practice of medicine."},{"startTime":1082.43,"endTime":1086.96,"body":"Now, syphilis, although"},{"startTime":1082.43,"endTime":1086.96,"body":"passed on sexually,"},{"startTime":1086.96,"endTime":1089.32,"body":"is a disease of the whole body."},{"startTime":1089.32,"endTime":1093.61,"body":"Primary, it starts off with a shanker,"},{"startTime":1093.61,"endTime":1097.37,"body":"which is a ulcer that's usually painless"},{"startTime":1097.37,"endTime":1100.08,"body":"lasting three to six weeks."},{"startTime":1100.08,"endTime":1102.61,"body":"Trivial of no great importance."},{"startTime":1102.61,"endTime":1107.6,"body":"Normally in the genitals can"},{"startTime":1102.61,"endTime":1107.6,"body":"be slightly different forms"},{"startTime":1107.6,"endTime":1109.903,"body":"in the throat or perianally."},{"startTime":1111.1,"endTime":1114.37,"body":"Secondary syphilis then follows after that"},{"startTime":1114.37,"endTime":1117.87,"body":"and causes a fever and a generalized rash,"},{"startTime":1117.87,"endTime":1121.91,"body":"various ulcers, people"},{"startTime":1117.87,"endTime":1121.91,"body":"feeling fairly unwell."},{"startTime":1121.91,"endTime":1123.75,"body":"And then for most people that passes,"},{"startTime":1123.75,"endTime":1126.78,"body":"although initially, here that"},{"startTime":1123.75,"endTime":1126.78,"body":"was really pretty serious"},{"startTime":1126.78,"endTime":1129.693,"body":"for many people, particularly"},{"startTime":1126.78,"endTime":1129.693,"body":"in the first wave."},{"startTime":1130.67,"endTime":1133.85,"body":"And then you end up"},{"startTime":1130.67,"endTime":1133.85,"body":"with tertiary syphilis,"},{"startTime":1133.85,"endTime":1137.79,"body":"which can occur 10 to 30 years later."},{"startTime":1137.79,"endTime":1140.55,"body":"And this can cause really serious problems"},{"startTime":1140.55,"endTime":1141.43,"body":"throughout the body."},{"startTime":1141.43,"endTime":1143.9,"body":"And syphilis was known as the great mimic"},{"startTime":1143.9,"endTime":1146.05,"body":"and cause problems in the brain"},{"startTime":1146.05,"endTime":1150.0,"body":"with the nerves, with the"},{"startTime":1146.05,"endTime":1150.0,"body":"eye, and this included"},{"startTime":1150.0,"endTime":1153.223,"body":"something called general"},{"startTime":1150.0,"endTime":1153.223,"body":"paresis insane, GPI."},{"startTime":1154.17,"endTime":1157.56,"body":"And this was something which caused"},{"startTime":1157.56,"endTime":1161.9,"body":"both mental and dementia problems."},{"startTime":1161.9,"endTime":1163.63,"body":"And dementia was a very significant"},{"startTime":1163.63,"endTime":1166.29,"body":"long-term of syphilis."},{"startTime":1166.29,"endTime":1168.79,"body":"And for example, something"},{"startTime":1166.29,"endTime":1168.79,"body":"called tabes doraslis,"},{"startTime":1168.79,"endTime":1173.79,"body":"really painful shooting pain in the limbs"},{"startTime":1174.92,"endTime":1178.33,"body":"caused problems in the"},{"startTime":1174.92,"endTime":1178.33,"body":"bones, in the joints,"},{"startTime":1178.33,"endTime":1180.79,"body":"multiple kinds of things on the skins,"},{"startTime":1180.79,"endTime":1182.68,"body":"lots of different kinds of skin rashes"},{"startTime":1182.68,"endTime":1185.0,"body":"also can cause inflammation of the heart"},{"startTime":1185.0,"endTime":1188.58,"body":"and swelling and inflammation"},{"startTime":1185.0,"endTime":1188.58,"body":"of the great blood vessels"},{"startTime":1188.58,"endTime":1190.24,"body":"and of the liver."},{"startTime":1190.24,"endTime":1192.87,"body":"So this was a multi-system disease"},{"startTime":1192.87,"endTime":1196.0,"body":"and extremely dangerous over many years,"},{"startTime":1196.0,"endTime":1198.7,"body":"taking different forms at"},{"startTime":1196.0,"endTime":1198.7,"body":"different stages of life."},{"startTime":1198.7,"endTime":1200.92,"body":"And on the right I've illustrated this"},{"startTime":1200.92,"endTime":1204.07,"body":"with what is probably the"},{"startTime":1200.92,"endTime":1204.07,"body":"first known illustration"},{"startTime":1204.07,"endTime":1208.293,"body":"of this treatment being treated in 1498."},{"startTime":1212.03,"endTime":1213.989,"body":"Now the initial treatment"},{"startTime":1213.989,"endTime":1217.71,"body":"came from a variety of different sources,"},{"startTime":1217.71,"endTime":1219.37,"body":"included herbal treatments,"},{"startTime":1219.37,"endTime":1223.323,"body":"which were traditional in"},{"startTime":1219.37,"endTime":1223.323,"body":"Europe at the stage, mercury,"},{"startTime":1224.24,"endTime":1226.573,"body":"partly 'cause it was thought"},{"startTime":1224.24,"endTime":1226.573,"body":"to look slightly like leprosy,"},{"startTime":1227.47,"endTime":1230.23,"body":"which was treated this"},{"startTime":1227.47,"endTime":1230.23,"body":"way and various woods"},{"startTime":1230.23,"endTime":1235.23,"body":"and other exotic herbs,"},{"startTime":1230.23,"endTime":1235.23,"body":"for example, Garcon,"},{"startTime":1235.25,"endTime":1237.95,"body":"which came from a wood"},{"startTime":1235.25,"endTime":1237.95,"body":"particularly imported"},{"startTime":1237.95,"endTime":1239.4,"body":"from Latin America initially."},{"startTime":1241.11,"endTime":1245.993,"body":"As a new disease, it"},{"startTime":1241.11,"endTime":1245.993,"body":"wasn't fully described"},{"startTime":1247.47,"endTime":1250.34,"body":"or wasn't described at all"},{"startTime":1247.47,"endTime":1250.34,"body":"actually in the ancient texts."},{"startTime":1250.34,"endTime":1252.95,"body":"And I think it's important to"},{"startTime":1250.34,"endTime":1252.95,"body":"remember back to this period,"},{"startTime":1252.95,"endTime":1254.71,"body":"much of traditional medicine"},{"startTime":1254.71,"endTime":1256.94,"body":"was about reading the ancient texts,"},{"startTime":1256.94,"endTime":1259.5,"body":"particularly the Greek"},{"startTime":1256.94,"endTime":1259.5,"body":"texts of Socrates and Galen"},{"startTime":1259.5,"endTime":1263.94,"body":"and others, and using"},{"startTime":1259.5,"endTime":1263.94,"body":"their approach to medicine."},{"startTime":1263.94,"endTime":1266.76,"body":"And there was a real medical conservatism"},{"startTime":1266.76,"endTime":1269.4,"body":"that meant that people were not wishing"},{"startTime":1269.4,"endTime":1272.62,"body":"to move away from that very traditional"},{"startTime":1272.62,"endTime":1274.12,"body":"form of medical practice."},{"startTime":1274.12,"endTime":1277.71,"body":"As a new disease, this"},{"startTime":1274.12,"endTime":1277.71,"body":"allowed for a complete rethink"},{"startTime":1277.71,"endTime":1279.89,"body":"of medicine and some of"},{"startTime":1277.71,"endTime":1279.89,"body":"the more radical thinkers"},{"startTime":1279.89,"endTime":1282.017,"body":"in medicine at that"},{"startTime":1279.89,"endTime":1282.017,"body":"point said that syphilis"},{"startTime":1282.017,"endTime":1285.22,"body":"had still got so entwined"},{"startTime":1282.017,"endTime":1285.22,"body":"with all the other diseases"},{"startTime":1285.22,"endTime":1287.75,"body":"that it led to a need"},{"startTime":1285.22,"endTime":1287.75,"body":"for a complete rethink"},{"startTime":1287.75,"endTime":1289.08,"body":"of medical theory and practice."},{"startTime":1289.08,"endTime":1292.95,"body":"And it, for example, made chemical drugs,"},{"startTime":1292.95,"endTime":1294.98,"body":"which had been much less respectable,"},{"startTime":1294.98,"endTime":1297.2,"body":"things like sulfur and mercury,"},{"startTime":1297.2,"endTime":1299.09,"body":"semi respectable, led to a new,"},{"startTime":1299.09,"endTime":1301.1,"body":"several new branches of medicine."},{"startTime":1301.1,"endTime":1304.21,"body":"It allowed surgeons to start"},{"startTime":1301.1,"endTime":1304.21,"body":"to practice much more widely"},{"startTime":1304.21,"endTime":1307.43,"body":"than they previously"},{"startTime":1304.21,"endTime":1307.43,"body":"had because used pastes"},{"startTime":1307.43,"endTime":1310.45,"body":"and oils, rather than just internal drugs,"},{"startTime":1310.45,"endTime":1313.2,"body":"which were the preserve of"},{"startTime":1310.45,"endTime":1313.2,"body":"other medical practitioners,"},{"startTime":1314.965,"endTime":1315.9,"body":"positions, led to quite a lot of building"},{"startTime":1315.9,"endTime":1320.0,"body":"or conversion of new"},{"startTime":1315.9,"endTime":1320.0,"body":"medical establishments."},{"startTime":1320.0,"endTime":1321.44,"body":"Some of the old leprosy hospitals"},{"startTime":1321.44,"endTime":1323.75,"body":"were turned into syphilis hospitals"},{"startTime":1323.75,"endTime":1326.06,"body":"from Lazarre houses to Locke hospitals,"},{"startTime":1326.06,"endTime":1328.75,"body":"wards are built, for example,"},{"startTime":1326.06,"endTime":1328.75,"body":"just up the road from here,"},{"startTime":1328.75,"endTime":1331.49,"body":"the Daughter ward at St Bartholomew's."},{"startTime":1331.49,"endTime":1333.539,"body":"And it had a very"},{"startTime":1331.49,"endTime":1333.539,"body":"substantial effect on society"},{"startTime":1333.539,"endTime":1336.31,"body":"where it probably changed"},{"startTime":1333.539,"endTime":1336.31,"body":"quite a lot of behaviors."},{"startTime":1336.31,"endTime":1338.46,"body":"And on literature, you"},{"startTime":1336.31,"endTime":1338.46,"body":"won't get through many,"},{"startTime":1338.46,"endTime":1340.75,"body":"or you certainly won't get"},{"startTime":1338.46,"endTime":1340.75,"body":"too many restoration comedies"},{"startTime":1340.75,"endTime":1343.37,"body":"in many Shakespeare plays"},{"startTime":1343.37,"endTime":1345.983,"body":"without some indirect reference to it."},{"startTime":1350.17,"endTime":1353.05,"body":"And it remained a really"},{"startTime":1350.17,"endTime":1353.05,"body":"very serious disease,"},{"startTime":1353.05,"endTime":1356.01,"body":"both in numbers, as well"},{"startTime":1353.05,"endTime":1356.01,"body":"as in its medical impact"},{"startTime":1356.01,"endTime":1358.33,"body":"right up to the antibiotic era."},{"startTime":1358.33,"endTime":1362.33,"body":"And if you go down to about 1919,"},{"startTime":1362.33,"endTime":1366.41,"body":"a Royal commission"},{"startTime":1362.33,"endTime":1366.41,"body":"assessed that around 10%"},{"startTime":1366.41,"endTime":1368.2,"body":"of the adult male population"},{"startTime":1368.2,"endTime":1370.63,"body":"of London had it at that stage."},{"startTime":1370.63,"endTime":1373.58,"body":"In the US army, it was the"},{"startTime":1370.63,"endTime":1373.58,"body":"second most common of illness"},{"startTime":1373.58,"endTime":1376.1,"body":"leading to loss of duty,"},{"startTime":1376.1,"endTime":1378.99,"body":"only exceeded by the great flu pandemic,"},{"startTime":1378.99,"endTime":1381.683,"body":"massive pandemic of 1819."},{"startTime":1383.382,"endTime":1385.06,"body":"It was one of the"},{"startTime":1383.382,"endTime":1385.06,"body":"communist causes dementia"},{"startTime":1385.06,"endTime":1387.82,"body":"if you went back 120 years,"},{"startTime":1387.82,"endTime":1390.77,"body":"and what changed that"},{"startTime":1387.82,"endTime":1390.77,"body":"where the introduction"},{"startTime":1390.77,"endTime":1394.83,"body":"of the first really good"},{"startTime":1390.77,"endTime":1394.83,"body":"antibacterial drugs,"},{"startTime":1394.83,"endTime":1397.88,"body":"first of all, moderately effective"},{"startTime":1397.88,"endTime":1402.023,"body":"and relatively more dangerous"},{"startTime":1397.88,"endTime":1402.023,"body":"arsenic-based drug, Salvarsan,"},{"startTime":1402.86,"endTime":1405.56,"body":"which was introduced in 1910."},{"startTime":1405.56,"endTime":1407.52,"body":"And the thing which really transformed it"},{"startTime":1407.52,"endTime":1410.51,"body":"was the was penicillin,"},{"startTime":1407.52,"endTime":1410.51,"body":"which remains a mainstay"},{"startTime":1410.51,"endTime":1412.2,"body":"of treatment of syphilis to this day,"},{"startTime":1412.2,"endTime":1416.11,"body":"largely collapsed the epidemic"},{"startTime":1412.2,"endTime":1416.11,"body":"in high-income countries."},{"startTime":1416.11,"endTime":1420.16,"body":"And if people were treated"},{"startTime":1416.11,"endTime":1420.16,"body":"potentially for other infections,"},{"startTime":1420.16,"endTime":1422.37,"body":"which they might not even"},{"startTime":1420.16,"endTime":1422.37,"body":"know they had syphilis,"},{"startTime":1422.37,"endTime":1425.267,"body":"between the initial infection"},{"startTime":1422.37,"endTime":1425.267,"body":"and their late complications,"},{"startTime":1425.267,"endTime":1428.32,"body":"it could prevent those late complications,"},{"startTime":1428.32,"endTime":1430.96,"body":"but to get rid of this as a"},{"startTime":1428.32,"endTime":1430.96,"body":"major public health problem,"},{"startTime":1430.96,"endTime":1432.02,"body":"there was also a need,"},{"startTime":1432.02,"endTime":1436.21,"body":"and this was set up, to"},{"startTime":1432.02,"endTime":1436.21,"body":"have a whole medical service"},{"startTime":1436.21,"endTime":1439.21,"body":"associated with finding people with cases"},{"startTime":1439.21,"endTime":1442.06,"body":"and then finding their contacts"},{"startTime":1439.21,"endTime":1442.06,"body":"and treating all of them."},{"startTime":1443.27,"endTime":1446.82,"body":"And this really led to a"},{"startTime":1443.27,"endTime":1446.82,"body":"significant transformation"},{"startTime":1446.82,"endTime":1449.383,"body":"of this major sexually"},{"startTime":1446.82,"endTime":1449.383,"body":"transmitted infection."},{"startTime":1451.35,"endTime":1454.35,"body":"Now, the way in which"},{"startTime":1451.35,"endTime":1454.35,"body":"cases were calculated"},{"startTime":1454.35,"endTime":1456.6,"body":"was varied over time."},{"startTime":1456.6,"endTime":1460.02,"body":"But as you can see, there was"},{"startTime":1456.6,"endTime":1460.02,"body":"a really substantial numbers"},{"startTime":1460.02,"endTime":1462.71,"body":"of cases of syphilis diagnosed in England,"},{"startTime":1462.71,"endTime":1465.33,"body":"up until the 1950s."},{"startTime":1465.33,"endTime":1467.21,"body":"And then those numbers really collapsed."},{"startTime":1467.21,"endTime":1469.77,"body":"And this is the impact of penicillin,"},{"startTime":1469.77,"endTime":1472.46,"body":"a little bit of a rise subsequent to that."},{"startTime":1472.46,"endTime":1475.5,"body":"Then a fall away probably"},{"startTime":1472.46,"endTime":1475.5,"body":"driven by changes"},{"startTime":1475.5,"endTime":1478.63,"body":"in sexual behavior around"},{"startTime":1475.5,"endTime":1478.63,"body":"the existence of HIV."},{"startTime":1478.63,"endTime":1481.068,"body":"And more recently, a bit of a comeback,"},{"startTime":1481.068,"endTime":1485.193,"body":"particularly in England, in"},{"startTime":1481.068,"endTime":1485.193,"body":"men who have sex with men,"},{"startTime":1486.45,"endTime":1487.45,"body":"but not exclusively."},{"startTime":1489.31,"endTime":1492.07,"body":"So that's syphilis, a really"},{"startTime":1489.31,"endTime":1492.07,"body":"major disease, historically,"},{"startTime":1492.07,"endTime":1494.423,"body":"even more important,"},{"startTime":1492.07,"endTime":1494.423,"body":"but still non-trivial."},{"startTime":1496.19,"endTime":1500.45,"body":"Then we move on to HIV,"},{"startTime":1496.19,"endTime":1500.45,"body":"AIDS and between the 1980s"},{"startTime":1500.45,"endTime":1504.4,"body":"and the 2020s, HIV AIDS has"},{"startTime":1500.45,"endTime":1504.4,"body":"been one of the most severe"},{"startTime":1504.4,"endTime":1507.81,"body":"new threats to health in the lifetime"},{"startTime":1507.81,"endTime":1509.689,"body":"of most people who are"},{"startTime":1507.81,"endTime":1509.689,"body":"watching this program."},{"startTime":1509.689,"endTime":1513.19,"body":"Over 36 million people have died to date,"},{"startTime":1513.19,"endTime":1517.81,"body":"more will do so, and this"},{"startTime":1513.19,"endTime":1517.81,"body":"has been a problem worldwide."},{"startTime":1517.81,"endTime":1522.81,"body":"So this is the last really"},{"startTime":1517.81,"endTime":1522.81,"body":"a remarkably bad pandemic"},{"startTime":1523.05,"endTime":1526.98,"body":"before we reached COVID"},{"startTime":1523.05,"endTime":1526.98,"body":"particularly true in Africa,"},{"startTime":1526.98,"endTime":1530.35,"body":"but all around the world,"},{"startTime":1526.98,"endTime":1530.35,"body":"including here in the UK"},{"startTime":1530.35,"endTime":1533.64,"body":"and the photo on the right"},{"startTime":1530.35,"endTime":1533.64,"body":"is from a book about a ward"},{"startTime":1533.64,"endTime":1536.003,"body":"I actually used to work"},{"startTime":1533.64,"endTime":1536.003,"body":"on early in my career."},{"startTime":1539.04,"endTime":1544.04,"body":"The early years of HIV are"},{"startTime":1539.04,"endTime":1544.04,"body":"still being researched,"},{"startTime":1544.95,"endTime":1549.6,"body":"but what is clear is"},{"startTime":1544.95,"endTime":1549.6,"body":"that this jumped species,"},{"startTime":1549.6,"endTime":1553.203,"body":"and it was originally"},{"startTime":1549.6,"endTime":1553.203,"body":"one of the family of,"},{"startTime":1554.062,"endTime":1558.227,"body":"or more than one of the"},{"startTime":1554.062,"endTime":1558.227,"body":"family of Simian viruses, SIV."},{"startTime":1560.75,"endTime":1564.1,"body":"And it crossed several"},{"startTime":1560.75,"endTime":1564.1,"body":"times between monkeys,"},{"startTime":1564.1,"endTime":1566.7,"body":"probably among hunters,"},{"startTime":1564.1,"endTime":1566.7,"body":"probably blood to blood"},{"startTime":1567.715,"endTime":1569.92,"body":"actually, to humans, leading to HIV,"},{"startTime":1569.92,"endTime":1573.564,"body":"which was probably"},{"startTime":1569.92,"endTime":1573.564,"body":"started in what was then,"},{"startTime":1573.564,"endTime":1577.73,"body":"now DRC from chimpanzees and separately,"},{"startTime":1577.73,"endTime":1581.06,"body":"HIV2, a slightly different"},{"startTime":1577.73,"endTime":1581.06,"body":"version of it in west Africa."},{"startTime":1581.06,"endTime":1583.88,"body":"And probably these were"},{"startTime":1581.06,"endTime":1583.88,"body":"circulating in humans"},{"startTime":1583.88,"endTime":1587.993,"body":"from the 1920s, certainly"},{"startTime":1583.88,"endTime":1587.993,"body":"before it was first picked up."},{"startTime":1589.04,"endTime":1591.24,"body":"It was first identified in the 1980s"},{"startTime":1591.24,"endTime":1595.28,"body":"and the 1981, gay men in California"},{"startTime":1595.28,"endTime":1599.99,"body":"developed a very rare lung"},{"startTime":1595.28,"endTime":1599.99,"body":"disease, something called PCP,"},{"startTime":1599.99,"endTime":1604.99,"body":"not normally seen otherwise"},{"startTime":1599.99,"endTime":1604.99,"body":"in young men or young people,"},{"startTime":1605.49,"endTime":1607.82,"body":"in New York, there was a"},{"startTime":1605.49,"endTime":1607.82,"body":"whole cluster of people"},{"startTime":1607.82,"endTime":1611.08,"body":"who had again, a kind of cancer,"},{"startTime":1611.08,"endTime":1614.25,"body":"which is extremely rare"},{"startTime":1611.08,"endTime":1614.25,"body":"in the general population"},{"startTime":1614.25,"endTime":1616.31,"body":"called Kaposi's sarcoma."},{"startTime":1616.31,"endTime":1619.57,"body":"Other groups were found"},{"startTime":1616.31,"endTime":1619.57,"body":"around intravenous drug users"},{"startTime":1619.57,"endTime":1622.53,"body":"in the USA and simultaneously"},{"startTime":1622.53,"endTime":1626.14,"body":"or near simultaneously,"},{"startTime":1622.53,"endTime":1626.14,"body":"cases started to be described"},{"startTime":1626.14,"endTime":1627.42,"body":"of what's called slim disease"},{"startTime":1627.42,"endTime":1629.66,"body":"and a variety of other forms in Uganda,"},{"startTime":1629.66,"endTime":1630.8,"body":"and then elsewhere in Africa."},{"startTime":1630.8,"endTime":1634.61,"body":"So early 1980s, lots of"},{"startTime":1630.8,"endTime":1634.61,"body":"people were diagnosed"},{"startTime":1634.61,"endTime":1637.35,"body":"and they were being"},{"startTime":1634.61,"endTime":1637.35,"body":"diagnosed not with HIV,"},{"startTime":1637.35,"endTime":1639.56,"body":"which at that point had"},{"startTime":1637.35,"endTime":1639.56,"body":"not been identified,"},{"startTime":1639.56,"endTime":1643.36,"body":"but with AIDS, a very serious disease,"},{"startTime":1643.36,"endTime":1646.863,"body":"which at that point was for"},{"startTime":1643.36,"endTime":1646.863,"body":"practical purposes, 100% fatal."},{"startTime":1649.51,"endTime":1653.263,"body":"Now HIV, which is transmitted"},{"startTime":1649.51,"endTime":1653.263,"body":"sexually in the main,"},{"startTime":1654.57,"endTime":1658.24,"body":"it destroys key parts"},{"startTime":1654.57,"endTime":1658.24,"body":"of the immune system,"},{"startTime":1658.24,"endTime":1660.24,"body":"particularly the bits that are mediated"},{"startTime":1660.24,"endTime":1663.2,"body":"by what's called the CD4 cells,"},{"startTime":1663.2,"endTime":1665.447,"body":"but it takes many years to do that."},{"startTime":1665.447,"endTime":1667.55,"body":"And on the right here,"},{"startTime":1667.55,"endTime":1671.92,"body":"what we have is the"},{"startTime":1667.55,"endTime":1671.92,"body":"kind of schematic in red"},{"startTime":1671.92,"endTime":1676.92,"body":"is the cell count where"},{"startTime":1671.92,"endTime":1676.92,"body":"high is good and low is bad."},{"startTime":1677.37,"endTime":1679.31,"body":"And in the blue we have the virus."},{"startTime":1679.31,"endTime":1681.47,"body":"And what you initially have"},{"startTime":1679.31,"endTime":1681.47,"body":"is a little bit of a dip,"},{"startTime":1681.47,"endTime":1684.8,"body":"but then the immune system"},{"startTime":1681.47,"endTime":1684.8,"body":"recovers for a number of years,"},{"startTime":1684.8,"endTime":1688.85,"body":"usually eight or more in most people."},{"startTime":1688.85,"endTime":1691.72,"body":"And then it begins to"},{"startTime":1688.85,"endTime":1691.72,"body":"deteriorate over time."},{"startTime":1691.72,"endTime":1694.23,"body":"And as it deteriorates,"},{"startTime":1691.72,"endTime":1694.23,"body":"people begin to get"},{"startTime":1694.23,"endTime":1697.84,"body":"more and more infections"},{"startTime":1694.23,"endTime":1697.84,"body":"and when they happen,"},{"startTime":1697.84,"endTime":1700.94,"body":"they are much more dangerous"},{"startTime":1697.84,"endTime":1700.94,"body":"than they would have been"},{"startTime":1700.94,"endTime":1702.68,"body":"in people who had an intact immune system."},{"startTime":1702.68,"endTime":1703.58,"body":"So the immune system,"},{"startTime":1703.58,"endTime":1705.5,"body":"this key part of the immune system"},{"startTime":1705.5,"endTime":1710.14,"body":"is essentially gradually"},{"startTime":1705.5,"endTime":1710.14,"body":"eroded to almost nothing."},{"startTime":1710.14,"endTime":1712.88,"body":"Things like TB, pneumococcal pneumonia."},{"startTime":1712.88,"endTime":1716.15,"body":"Some salmonella's, various"},{"startTime":1712.88,"endTime":1716.15,"body":"forms of meningitis,"},{"startTime":1716.15,"endTime":1717.58,"body":"including fungal ones,"},{"startTime":1717.58,"endTime":1721.01,"body":"several fungal infections"},{"startTime":1717.58,"endTime":1721.01,"body":"of the lungs, of the brain"},{"startTime":1722.14,"endTime":1724.56,"body":"in particular, the body more generally."},{"startTime":1724.56,"endTime":1728.36,"body":"And also because the immune"},{"startTime":1724.56,"endTime":1728.36,"body":"system scans the body for cancer"},{"startTime":1728.36,"endTime":1732.05,"body":"and helps to destroy cancers,"},{"startTime":1732.05,"endTime":1735.8,"body":"several cancers or cancers"},{"startTime":1732.05,"endTime":1735.8,"body":"driven by infections,"},{"startTime":1735.8,"endTime":1737.29,"body":"such as Kaposi's sarcoma."},{"startTime":1737.29,"endTime":1739.86,"body":"So not having CD4 cells"},{"startTime":1739.86,"endTime":1741.72,"body":"and the immune system that goes with them"},{"startTime":1741.72,"endTime":1745.16,"body":"leads to multiple, very serious diseases."},{"startTime":1745.16,"endTime":1747.94,"body":"And this is what some"},{"startTime":1745.16,"endTime":1747.94,"body":"combinations of these"},{"startTime":1747.94,"endTime":1751.393,"body":"is what constituted the group"},{"startTime":1747.94,"endTime":1751.393,"body":"of syndromes caused AIDS."},{"startTime":1756.5,"endTime":1758.74,"body":"Once this has started to"},{"startTime":1756.5,"endTime":1758.74,"body":"circulate around the world"},{"startTime":1758.74,"endTime":1762.2,"body":"in this pandemic, several"},{"startTime":1758.74,"endTime":1762.2,"body":"different independent"},{"startTime":1762.2,"endTime":1766.05,"body":"essentially epidemics"},{"startTime":1762.2,"endTime":1766.05,"body":"that overlapped occurred,"},{"startTime":1766.05,"endTime":1770.173,"body":"which all of which led to HIV AIDS."},{"startTime":1771.11,"endTime":1773.95,"body":"There was a largely heterosexually driven"},{"startTime":1773.95,"endTime":1777.48,"body":"sexually transmitted infection epidemic,"},{"startTime":1777.48,"endTime":1779.167,"body":"particularly in Africa and"},{"startTime":1777.48,"endTime":1779.167,"body":"especially Southern Africa,"},{"startTime":1779.167,"endTime":1784.07,"body":"parts of Asia, parts of Latin"},{"startTime":1779.167,"endTime":1784.07,"body":"America, but also Europe."},{"startTime":1784.07,"endTime":1785.41,"body":"This was by far the largest."},{"startTime":1785.41,"endTime":1787.93,"body":"So the greatest majority"},{"startTime":1785.41,"endTime":1787.93,"body":"in terms of numbers"},{"startTime":1787.93,"endTime":1792.93,"body":"was this large global"},{"startTime":1787.93,"endTime":1792.93,"body":"heterosexual STI epidemic."},{"startTime":1793.6,"endTime":1796.57,"body":"And there were many children"},{"startTime":1793.6,"endTime":1796.57,"body":"born to mothers who got HIV."},{"startTime":1796.57,"endTime":1799.38,"body":"So there was also a subsidiary epidemic"},{"startTime":1799.38,"endTime":1802.453,"body":"in children who died young."},{"startTime":1804.61,"endTime":1806.77,"body":"Then there was simultaneously,"},{"startTime":1806.77,"endTime":1811.04,"body":"a significant epidemic in"},{"startTime":1806.77,"endTime":1811.04,"body":"men who had sex with men,"},{"startTime":1811.04,"endTime":1814.02,"body":"particularly in Europe and north"},{"startTime":1811.04,"endTime":1814.02,"body":"America, but also globally."},{"startTime":1814.02,"endTime":1816.42,"body":"And there's obviously"},{"startTime":1814.02,"endTime":1816.42,"body":"overlap between these two."},{"startTime":1817.57,"endTime":1819.37,"body":"There was an epidemic amongst people"},{"startTime":1819.37,"endTime":1820.98,"body":"who were intravenous drug users,"},{"startTime":1820.98,"endTime":1823.1,"body":"because HIV, in addition to being"},{"startTime":1823.1,"endTime":1824.36,"body":"a sexually transmitted infection"},{"startTime":1824.36,"endTime":1827.24,"body":"is by far its predominant"},{"startTime":1824.36,"endTime":1827.24,"body":"means of transmission,"},{"startTime":1827.24,"endTime":1831.22,"body":"also a blood to blood"},{"startTime":1827.24,"endTime":1831.22,"body":"transmitted infection."},{"startTime":1831.22,"endTime":1833.11,"body":"And tragically, in addition"},{"startTime":1833.11,"endTime":1835.59,"body":"to these other multiple other tragedies,"},{"startTime":1835.59,"endTime":1839.16,"body":"there was some blood products"},{"startTime":1835.59,"endTime":1839.16,"body":"such as hemophilia suffers"},{"startTime":1839.16,"endTime":1842.38,"body":"where it got into the supply."},{"startTime":1842.38,"endTime":1845.63,"body":"So this led to large numbers"},{"startTime":1842.38,"endTime":1845.63,"body":"of people being infected."},{"startTime":1845.63,"endTime":1849.323,"body":"And initially, everybody who"},{"startTime":1845.63,"endTime":1849.323,"body":"was infected went on to die."},{"startTime":1852.49,"endTime":1856.42,"body":"The spread of this was really quite rapid."},{"startTime":1856.42,"endTime":1859.73,"body":"And these maps show the"},{"startTime":1856.42,"endTime":1859.73,"body":"spread from top left"},{"startTime":1859.73,"endTime":1864.07,"body":"to bottom right over from the mid eighties"},{"startTime":1864.07,"endTime":1867.04,"body":"through to the end of the 1990s."},{"startTime":1867.04,"endTime":1869.33,"body":"Really over this entire period in Africa,"},{"startTime":1869.33,"endTime":1871.739,"body":"the most effected continent,"},{"startTime":1869.33,"endTime":1871.739,"body":"although as I say,"},{"startTime":1871.739,"endTime":1875.16,"body":"it's in every continent,"},{"startTime":1871.739,"endTime":1875.16,"body":"it was really substantial."},{"startTime":1875.16,"endTime":1878.55,"body":"And over this period, there"},{"startTime":1875.16,"endTime":1878.55,"body":"was for practical purposes,"},{"startTime":1878.55,"endTime":1883.55,"body":"100% mortality and the numbers"},{"startTime":1878.55,"endTime":1883.55,"body":"infected were dramatic."},{"startTime":1886.23,"endTime":1889.95,"body":"Certainly at the point I was"},{"startTime":1886.23,"endTime":1889.95,"body":"a doctor in Southern Africa."},{"startTime":1889.95,"endTime":1892.64,"body":"Malawi at that stage,"},{"startTime":1889.95,"endTime":1892.64,"body":"there was a situation"},{"startTime":1892.64,"endTime":1894.62,"body":"where in many parts of Southern Africa,"},{"startTime":1894.62,"endTime":1898.098,"body":"up to 30 or even 40% of people,"},{"startTime":1898.098,"endTime":1903.098,"body":"of young adults were infected,"},{"startTime":1898.098,"endTime":1903.098,"body":"sample studies where I was"},{"startTime":1903.86,"endTime":1907.36,"body":"around 30% of pregnant women"},{"startTime":1903.86,"endTime":1907.36,"body":"in some studies had this,"},{"startTime":1907.36,"endTime":1908.61,"body":"all of them would go on to die."},{"startTime":1908.61,"endTime":1911.75,"body":"So if you think about the"},{"startTime":1908.61,"endTime":1911.75,"body":"impact of that on society,"},{"startTime":1911.75,"endTime":1913.523,"body":"it was very, very profound."},{"startTime":1916.76,"endTime":1918.62,"body":"In the absence of medical countermeasures,"},{"startTime":1918.62,"endTime":1921.5,"body":"drugs and vaccines, the initial response"},{"startTime":1921.5,"endTime":1925.09,"body":"had to rely almost entirely"},{"startTime":1925.09,"endTime":1927.18,"body":"on trying to change social behavior."},{"startTime":1927.18,"endTime":1929.52,"body":"Was of course of the net"},{"startTime":1927.18,"endTime":1929.52,"body":"sexually transmitted infection,"},{"startTime":1929.52,"endTime":1931.85,"body":"you don't have that ability to intervene"},{"startTime":1931.85,"endTime":1934.35,"body":"except by changing behavior."},{"startTime":1934.35,"endTime":1936.69,"body":"And some of these posters"},{"startTime":1934.35,"endTime":1936.69,"body":"are some of the ways"},{"startTime":1936.69,"endTime":1940.25,"body":"in which people tried to"},{"startTime":1936.69,"endTime":1940.25,"body":"change overall behaviors."},{"startTime":1940.25,"endTime":1945.2,"body":"Some, I would say more likely"},{"startTime":1940.25,"endTime":1945.2,"body":"to be successful than others."},{"startTime":1945.2,"endTime":1947.04,"body":"And it was also important,"},{"startTime":1947.04,"endTime":1949.87,"body":"as well as trying to change behaviors"},{"startTime":1949.87,"endTime":1952.54,"body":"that led to people reducing their risk,"},{"startTime":1952.54,"endTime":1955.6,"body":"having fewer partners, for example,"},{"startTime":1955.6,"endTime":1960.6,"body":"and taking precautions, also"},{"startTime":1955.6,"endTime":1960.6,"body":"to try and encourage people"},{"startTime":1960.75,"endTime":1962.94,"body":"to understand that they could not catch"},{"startTime":1962.94,"endTime":1964.628,"body":"this sexually transmitted infection"},{"startTime":1964.628,"endTime":1967.06,"body":"from ordinary social contact."},{"startTime":1967.06,"endTime":1969.33,"body":"There was a real fear"},{"startTime":1967.06,"endTime":1969.33,"body":"that you might pick it up"},{"startTime":1969.33,"endTime":1971.93,"body":"if you shared a workspace"},{"startTime":1969.33,"endTime":1971.93,"body":"or a friendship group"},{"startTime":1971.93,"endTime":1973.262,"body":"with someone with HIV."},{"startTime":1973.262,"endTime":1974.262,"body":"And of course that wasn't true,"},{"startTime":1974.262,"endTime":1975.095,"body":"unless you actually"},{"startTime":1976.317,"endTime":1977.393,"body":"were having a sexual"},{"startTime":1976.317,"endTime":1977.393,"body":"relationship with them."},{"startTime":1980.38,"endTime":1982.18,"body":"Probably the most"},{"startTime":1980.38,"endTime":1982.18,"body":"important early initiative"},{"startTime":1982.18,"endTime":1983.85,"body":"was the promotion of condoms"},{"startTime":1983.85,"endTime":1986.353,"body":"and other barrier"},{"startTime":1983.85,"endTime":1986.353,"body":"methods of contraception."},{"startTime":1987.31,"endTime":1990.0,"body":"And just like to make a"},{"startTime":1987.31,"endTime":1990.0,"body":"few points about this,"},{"startTime":1990.0,"endTime":1992.24,"body":"there was really no very good evidence"},{"startTime":1992.24,"endTime":1995.9,"body":"that abstinence only campaigns"},{"startTime":1992.24,"endTime":1995.9,"body":"had a major impact on HIV."},{"startTime":1995.9,"endTime":1998.3,"body":"That doesn't mean that it"},{"startTime":1995.9,"endTime":1998.3,"body":"didn't in individual cases,"},{"startTime":1998.3,"endTime":2003.1,"body":"but in terms of slowing the"},{"startTime":1998.3,"endTime":2003.1,"body":"epidemic down, on the flip side,"},{"startTime":2003.1,"endTime":2005.32,"body":"there was no good evidence"},{"startTime":2003.1,"endTime":2005.32,"body":"that condom promotion"},{"startTime":2005.32,"endTime":2007.01,"body":"in any way increased sexual activity,"},{"startTime":2007.01,"endTime":2009.13,"body":"no one was likely to have sexual behavior"},{"startTime":2009.13,"endTime":2011.79,"body":"because they had a"},{"startTime":2009.13,"endTime":2011.79,"body":"condom promoted to them,"},{"startTime":2011.79,"endTime":2015.06,"body":"if they weren't intending"},{"startTime":2011.79,"endTime":2015.06,"body":"to in the first place"},{"startTime":2015.06,"endTime":2016.99,"body":"and promoting condoms,"},{"startTime":2016.99,"endTime":2020.72,"body":"and for some people filming"},{"startTime":2016.99,"endTime":2020.72,"body":"female condoms and diaphragms"},{"startTime":2020.72,"endTime":2023.672,"body":"reduced significantly the risk of HIV"},{"startTime":2023.672,"endTime":2027.88,"body":"and importantly, other sexually"},{"startTime":2023.672,"endTime":2027.88,"body":"transmitted infections."},{"startTime":2027.88,"endTime":2030.633,"body":"But importantly also not to zero."},{"startTime":2031.66,"endTime":2034.38,"body":"An additional behavior which"},{"startTime":2031.66,"endTime":2034.38,"body":"was found to be important"},{"startTime":2034.38,"endTime":2036.8,"body":"slightly later in the"},{"startTime":2034.38,"endTime":2036.8,"body":"epidemic with circumcision,"},{"startTime":2036.8,"endTime":2039.653,"body":"which also reduces the"},{"startTime":2036.8,"endTime":2039.653,"body":"risk of HIV transmission."},{"startTime":2043.53,"endTime":2046.02,"body":"But the really big transformation"},{"startTime":2046.02,"endTime":2050.92,"body":"occurred with the advent of"},{"startTime":2046.02,"endTime":2050.92,"body":"drugs to treat this terrible,"},{"startTime":2050.92,"endTime":2053.203,"body":"entirely fatal, new disease."},{"startTime":2054.54,"endTime":2056.24,"body":"We got no vaccine for HIV yet"},{"startTime":2056.24,"endTime":2058.23,"body":"that's available in widespread use."},{"startTime":2058.23,"endTime":2063.23,"body":"Obviously it is still being"},{"startTime":2058.23,"endTime":2063.23,"body":"looked for, but since the 1980s,"},{"startTime":2063.64,"endTime":2067.72,"body":"many very effective drugs"},{"startTime":2063.64,"endTime":2067.72,"body":"have been introduced."},{"startTime":2067.72,"endTime":2070.55,"body":"The highly effective antiretrovirals,"},{"startTime":2070.55,"endTime":2071.903,"body":"sometimes known as HAART."},{"startTime":2073.031,"endTime":2076.55,"body":"And they were really"},{"startTime":2073.031,"endTime":2076.55,"body":"available from the mid 1990s."},{"startTime":2076.55,"endTime":2078.6,"body":"Initially they were moderately effective,"},{"startTime":2078.6,"endTime":2080.59,"body":"had significant side effects,"},{"startTime":2080.59,"endTime":2083.46,"body":"very expensive, complex to deal with,"},{"startTime":2083.46,"endTime":2085.2,"body":"lots of drug resistance,"},{"startTime":2085.2,"endTime":2087.27,"body":"but there have been steady"},{"startTime":2085.2,"endTime":2087.27,"body":"improvements over time."},{"startTime":2087.27,"endTime":2089.07,"body":"And medicine always tends to advance,"},{"startTime":2089.07,"endTime":2090.37,"body":"not by sudden breakthroughs,"},{"startTime":2090.37,"endTime":2094.49,"body":"but by incremental improvements,"},{"startTime":2090.37,"endTime":2094.49,"body":"one on top of another."},{"startTime":2094.49,"endTime":2098.81,"body":"And this poster, I think"},{"startTime":2094.49,"endTime":2098.81,"body":"rather well illustrates"},{"startTime":2098.81,"endTime":2101.39,"body":"how HIV is often moved from a situation"},{"startTime":2101.39,"endTime":2104.49,"body":"where people had to take"},{"startTime":2101.39,"endTime":2104.49,"body":"many drugs every day"},{"startTime":2104.49,"endTime":2108.3,"body":"to single drugs and even"},{"startTime":2104.49,"endTime":2108.3,"body":"most recently to injections,"},{"startTime":2108.3,"endTime":2110.37,"body":"they may be able to take for"},{"startTime":2108.3,"endTime":2110.37,"body":"prolonged periods of time."},{"startTime":2110.37,"endTime":2113.65,"body":"So steadily improvement and"},{"startTime":2110.37,"endTime":2113.65,"body":"the price dropped a lot."},{"startTime":2113.65,"endTime":2115.734,"body":"And for a variety of reasons,"},{"startTime":2115.734,"endTime":2119.64,"body":"some of which were to do with"},{"startTime":2115.734,"endTime":2119.64,"body":"important legal challenges,"},{"startTime":2119.64,"endTime":2121.62,"body":"they became available to"},{"startTime":2119.64,"endTime":2121.62,"body":"lower-income countries."},{"startTime":2121.62,"endTime":2123.263,"body":"Where in fact, the great majority"},{"startTime":2123.263,"endTime":2124.963,"body":"of people who had HIV were living."},{"startTime":2126.44,"endTime":2127.7,"body":"As a result of these drugs,"},{"startTime":2127.7,"endTime":2130.62,"body":"the life expectancy of HIV infected people"},{"startTime":2130.62,"endTime":2133.94,"body":"who are diagnosed early and treated"},{"startTime":2133.94,"endTime":2137.94,"body":"is basically the same as the non-infected,"},{"startTime":2137.94,"endTime":2141.05,"body":"but it is important that"},{"startTime":2137.94,"endTime":2141.05,"body":"people are diagnosed early."},{"startTime":2141.05,"endTime":2143.7,"body":"And cannot say this too often,"},{"startTime":2143.7,"endTime":2145.944,"body":"early diagnosis is the key to managing"},{"startTime":2145.944,"endTime":2149.033,"body":"potentially sexually"},{"startTime":2145.944,"endTime":2149.033,"body":"transmitted infections."},{"startTime":2152.4,"endTime":2154.28,"body":"So the introduction of these drugs"},{"startTime":2154.28,"endTime":2157.01,"body":"and then their spread worldwide"},{"startTime":2157.01,"endTime":2162.01,"body":"has led to a really major"},{"startTime":2157.01,"endTime":2162.01,"body":"reduction in deaths."},{"startTime":2163.31,"endTime":2168.31,"body":"And what this chart"},{"startTime":2163.31,"endTime":2168.31,"body":"shows is deaths by age."},{"startTime":2168.6,"endTime":2173.39,"body":"And those in red are people 15 to 49."},{"startTime":2173.39,"endTime":2176.62,"body":"So HIV was a disease, still is a disease"},{"startTime":2176.62,"endTime":2180.48,"body":"that predominantly kills people"},{"startTime":2176.62,"endTime":2180.48,"body":"in their young adulthood."},{"startTime":2180.48,"endTime":2182.95,"body":"And the introduction"},{"startTime":2180.48,"endTime":2182.95,"body":"of the antiretrovirals"},{"startTime":2182.95,"endTime":2185.2,"body":"has really brought that"},{"startTime":2182.95,"endTime":2185.2,"body":"down and in the countries"},{"startTime":2185.2,"endTime":2187.31,"body":"where there are widespread antiretrovirals"},{"startTime":2187.31,"endTime":2188.89,"body":"and have been for many years,"},{"startTime":2188.89,"endTime":2192.883,"body":"down to very close to nil,"},{"startTime":2188.89,"endTime":2192.883,"body":"will never be completely nil."},{"startTime":2195.43,"endTime":2196.72,"body":"it's also was found, and again,"},{"startTime":2196.72,"endTime":2198.63,"body":"this took a little while to be proved,"},{"startTime":2198.63,"endTime":2202.54,"body":"although it was theorized"},{"startTime":2198.63,"endTime":2202.54,"body":"from fairly early on,"},{"startTime":2202.54,"endTime":2204.511,"body":"that if you treat people effectively,"},{"startTime":2204.511,"endTime":2209.18,"body":"that reduces the chance that"},{"startTime":2204.511,"endTime":2209.18,"body":"they will pass on the disease"},{"startTime":2209.18,"endTime":2211.27,"body":"and the chance of someone with HIV"},{"startTime":2211.27,"endTime":2214.21,"body":"who is well controlled"},{"startTime":2211.27,"endTime":2214.21,"body":"and antiretrovirals,"},{"startTime":2214.21,"endTime":2216.6,"body":"passing on HIV to a partner"},{"startTime":2216.6,"endTime":2221.6,"body":"is close to for practical purposes, nil."},{"startTime":2222.55,"endTime":2224.38,"body":"So highly effective."},{"startTime":2224.38,"endTime":2225.86,"body":"So if people are in stable relationships"},{"startTime":2225.86,"endTime":2228.51,"body":"where one person's got"},{"startTime":2225.86,"endTime":2228.51,"body":"HIV and the other has not,"},{"startTime":2228.51,"endTime":2232.68,"body":"if the person with HIV is well controlled,"},{"startTime":2232.68,"endTime":2235.04,"body":"the risks to the other"},{"startTime":2232.68,"endTime":2235.04,"body":"person are absolutely minimal"},{"startTime":2235.04,"endTime":2236.693,"body":"from that relationship at least."},{"startTime":2238.06,"endTime":2240.95,"body":"Additionally for people,"},{"startTime":2240.95,"endTime":2242.987,"body":"we now also have some people"},{"startTime":2242.987,"endTime":2245.76,"body":"will use pre-exposure prophylaxis,"},{"startTime":2245.76,"endTime":2247.54,"body":"where they take antiretroviral drugs"},{"startTime":2247.54,"endTime":2251.41,"body":"if they're going to have"},{"startTime":2247.54,"endTime":2251.41,"body":"high risk sexual encounters"},{"startTime":2251.41,"endTime":2252.4,"body":"with someone they're not in"},{"startTime":2252.4,"endTime":2254.197,"body":"a stable relationship with in particular,"},{"startTime":2254.197,"endTime":2258.32,"body":"and this reduces"},{"startTime":2254.197,"endTime":2258.32,"body":"transmission by up to 99%."},{"startTime":2258.32,"endTime":2262.2,"body":"So these are drugs being"},{"startTime":2258.32,"endTime":2262.2,"body":"used to reduce transmission"},{"startTime":2262.2,"endTime":2263.913,"body":"in either direction."},{"startTime":2268.93,"endTime":2271.31,"body":"Despite that, the impact of HIV"},{"startTime":2271.31,"endTime":2274.42,"body":"on societies has been massive."},{"startTime":2274.42,"endTime":2276.21,"body":"This is a schematic, a relatively old one,"},{"startTime":2276.21,"endTime":2278.494,"body":"but I think it rather"},{"startTime":2276.21,"endTime":2278.494,"body":"powerfully illustrates"},{"startTime":2278.494,"endTime":2282.22,"body":"what kinds of impacts are"},{"startTime":2278.494,"endTime":2282.22,"body":"likely to have happened."},{"startTime":2282.22,"endTime":2287.22,"body":"In the light blue bars"},{"startTime":2282.22,"endTime":2287.22,"body":"is the age structure"},{"startTime":2287.36,"endTime":2289.96,"body":"the would've been in Botswana,"},{"startTime":2289.96,"endTime":2292.59,"body":"one of the most heavily"},{"startTime":2289.96,"endTime":2292.59,"body":"affected countries in the world,"},{"startTime":2292.59,"endTime":2296.38,"body":"and in the dark blue is"},{"startTime":2292.59,"endTime":2296.38,"body":"what the age structure was"},{"startTime":2296.38,"endTime":2299.02,"body":"as a result of this pandemic."},{"startTime":2299.02,"endTime":2303.7,"body":"And what you can see is that the impact"},{"startTime":2303.7,"endTime":2305.393,"body":"was really very profound."},{"startTime":2307.8,"endTime":2309.15,"body":"And if you think about what happens"},{"startTime":2309.15,"endTime":2313.32,"body":"when you remove such large"},{"startTime":2309.15,"endTime":2313.32,"body":"proportions of young adults,"},{"startTime":2313.32,"endTime":2317.583,"body":"of working age, parents"},{"startTime":2313.32,"endTime":2317.583,"body":"and also of children,"},{"startTime":2318.88,"endTime":2320.59,"body":"the impacts were obviously tragic"},{"startTime":2320.59,"endTime":2322.413,"body":"and extraordinarily widespread."},{"startTime":2324.95,"endTime":2327.2,"body":"There was also a significant epidemic"},{"startTime":2327.2,"endTime":2330.9,"body":"in children and in the early HIV epidemic,"},{"startTime":2330.9,"endTime":2333.574,"body":"between 50 and 45% of all"},{"startTime":2330.9,"endTime":2333.574,"body":"children to HIV positive women"},{"startTime":2333.574,"endTime":2335.89,"body":"were infected."},{"startTime":2335.89,"endTime":2339.09,"body":"And of course the women"},{"startTime":2335.89,"endTime":2339.09,"body":"themselves would go on to die."},{"startTime":2339.09,"endTime":2343.48,"body":"And usually if they had HIV,"},{"startTime":2339.09,"endTime":2343.48,"body":"their partner would have HIV."},{"startTime":2343.48,"endTime":2346.49,"body":"So the children who were not"},{"startTime":2343.48,"endTime":2346.49,"body":"infected were left as orphans."},{"startTime":2346.49,"endTime":2348.863,"body":"So it effected people in multiple ways."},{"startTime":2350.03,"endTime":2353.604,"body":"Most of those were infected"},{"startTime":2350.03,"endTime":2353.604,"body":"actually in the birthing process"},{"startTime":2353.604,"endTime":2355.752,"body":"or during pregnancy,"},{"startTime":2355.752,"endTime":2359.63,"body":"but pregnancy and breastfeeding"},{"startTime":2355.752,"endTime":2359.63,"body":"were also important."},{"startTime":2359.63,"endTime":2362.83,"body":"So you could pass it on various"},{"startTime":2359.63,"endTime":2362.83,"body":"stages in the early life,"},{"startTime":2362.83,"endTime":2365.323,"body":"but particularly in the birthing process,"},{"startTime":2366.2,"endTime":2370.02,"body":"as a result of using"},{"startTime":2366.2,"endTime":2370.02,"body":"highly effective drugs,"},{"startTime":2370.02,"endTime":2371.54,"body":"this is now less than 1%."},{"startTime":2371.54,"endTime":2373.83,"body":"Really this has dropped away, in the UK,"},{"startTime":2373.83,"endTime":2376.1,"body":"less than 0.5% transmission."},{"startTime":2376.1,"endTime":2378.52,"body":"The key thing being to identify it"},{"startTime":2378.52,"endTime":2381.09,"body":"in pregnancy and treat"},{"startTime":2378.52,"endTime":2381.09,"body":"it, and if necessary,"},{"startTime":2381.09,"endTime":2383.493,"body":"take additional precautions"},{"startTime":2381.09,"endTime":2383.493,"body":"around the birth."},{"startTime":2388.04,"endTime":2391.25,"body":"HIV though remains a major global threat,"},{"startTime":2391.25,"endTime":2395.52,"body":"and this is broadly the map"},{"startTime":2391.25,"endTime":2395.52,"body":"of the prevalence of HIV."},{"startTime":2395.52,"endTime":2399.2,"body":"How many people have it"},{"startTime":2395.52,"endTime":2399.2,"body":"now, down to where it was,"},{"startTime":2399.2,"endTime":2402.18,"body":"but still a very"},{"startTime":2399.2,"endTime":2402.18,"body":"significant global problem"},{"startTime":2402.18,"endTime":2405.263,"body":"and with HIV in every continent."},{"startTime":2407.45,"endTime":2409.27,"body":"But there have been"},{"startTime":2407.45,"endTime":2409.27,"body":"quite significant shifts"},{"startTime":2409.27,"endTime":2411.24,"body":"within that pattern."},{"startTime":2411.24,"endTime":2416.24,"body":"And this is just showing"},{"startTime":2411.24,"endTime":2416.24,"body":"where HIV prevalences,"},{"startTime":2416.36,"endTime":2420.96,"body":"and then the change over the"},{"startTime":2416.36,"endTime":2420.96,"body":"period between 2000, 2017."},{"startTime":2420.96,"endTime":2423.53,"body":"And you can see some areas,"},{"startTime":2420.96,"endTime":2423.53,"body":"for example in Africa,"},{"startTime":2423.53,"endTime":2425.98,"body":"the rates have gone right down in green"},{"startTime":2425.98,"endTime":2427.68,"body":"and some areas indeed, they've gone up."},{"startTime":2427.68,"endTime":2430.72,"body":"And this has to do with local"},{"startTime":2427.68,"endTime":2430.72,"body":"practices and particularly"},{"startTime":2430.72,"endTime":2433.563,"body":"how much treatment is"},{"startTime":2430.72,"endTime":2433.563,"body":"available and early diagnosis."},{"startTime":2436.08,"endTime":2440.1,"body":"In high-income countries, HIV"},{"startTime":2436.08,"endTime":2440.1,"body":"cases are now largely dropping"},{"startTime":2440.1,"endTime":2441.55,"body":"because people are identified early"},{"startTime":2441.55,"endTime":2442.8,"body":"and put on effective treatment,"},{"startTime":2442.8,"endTime":2444.43,"body":"which means they're"},{"startTime":2442.8,"endTime":2444.43,"body":"not likely to transmit,"},{"startTime":2444.43,"endTime":2446.8,"body":"and deaths are very rare."},{"startTime":2446.8,"endTime":2450.68,"body":"So in the UK, life expectancy"},{"startTime":2446.8,"endTime":2450.68,"body":"for people with HIV,"},{"startTime":2450.68,"endTime":2454.15,"body":"who are identified early"},{"startTime":2450.68,"endTime":2454.15,"body":"is for practical purposes"},{"startTime":2454.15,"endTime":2455.863,"body":"the same as for anyone else."},{"startTime":2456.92,"endTime":2459.23,"body":"And the rates of transmission are reducing"},{"startTime":2459.23,"endTime":2463.435,"body":"because of this effective treatment"},{"startTime":2463.435,"endTime":2466.227,"body":"in all the different routes,"},{"startTime":2463.435,"endTime":2466.227,"body":"by which this is transmitted."},{"startTime":2466.227,"endTime":2471.203,"body":"Men who have sex with men"},{"startTime":2466.227,"endTime":2471.203,"body":"heterosexually and others."},{"startTime":2473.72,"endTime":2476.729,"body":"So that's the two really major,"},{"startTime":2476.729,"endTime":2479.14,"body":"systemic diseases, sexually transmitted."},{"startTime":2479.14,"endTime":2481.37,"body":"Now I'd like to move on"},{"startTime":2479.14,"endTime":2481.37,"body":"to an important disease,"},{"startTime":2481.37,"endTime":2484.46,"body":"which causes cancer and that's"},{"startTime":2481.37,"endTime":2484.46,"body":"a human papilloma virus,"},{"startTime":2484.46,"endTime":2489.46,"body":"HPV, this is exceptionally"},{"startTime":2484.46,"endTime":2489.46,"body":"common and it's true."},{"startTime":2489.996,"endTime":2491.88,"body":"It's sexually transmitted at an early age."},{"startTime":2491.88,"endTime":2495.18,"body":"So young women tend to get it"},{"startTime":2495.18,"endTime":2497.883,"body":"very early in their"},{"startTime":2495.18,"endTime":2497.883,"body":"sexual lives very often."},{"startTime":2499.22,"endTime":2501.9,"body":"Now human papilloma virus,"},{"startTime":2499.22,"endTime":2501.9,"body":"there are a lot of them,"},{"startTime":2501.9,"endTime":2504.01,"body":"some of them are largely so trivial"},{"startTime":2504.01,"endTime":2505.45,"body":"that you don't get anything with them."},{"startTime":2505.45,"endTime":2508.91,"body":"Some of them cause warts,"},{"startTime":2505.45,"endTime":2508.91,"body":"which are not aesthetic"},{"startTime":2508.91,"endTime":2510.72,"body":"and can cause a lot of psychological"},{"startTime":2510.72,"endTime":2512.47,"body":"and sometimes relationship distress,"},{"startTime":2512.47,"endTime":2515.51,"body":"but they're not dangerous,"},{"startTime":2512.47,"endTime":2515.51,"body":"but there are some of them,"},{"startTime":2515.51,"endTime":2517.61,"body":"in particular, HPV 16 and 18,"},{"startTime":2517.61,"endTime":2520.5,"body":"but there are others which cause cancers."},{"startTime":2520.5,"endTime":2521.5,"body":"And in particular,"},{"startTime":2521.5,"endTime":2524.343,"body":"they tend to cause"},{"startTime":2521.5,"endTime":2524.343,"body":"cervical cancer in women."},{"startTime":2525.7,"endTime":2528.6,"body":"Globally around half a"},{"startTime":2525.7,"endTime":2528.6,"body":"million people are affected."},{"startTime":2528.6,"endTime":2533.21,"body":"And around 3000 cases"},{"startTime":2528.6,"endTime":2533.21,"body":"a year here in the UK,"},{"startTime":2533.21,"endTime":2535.43,"body":"and to put a kind of ratio on it,"},{"startTime":2535.43,"endTime":2538.77,"body":"roughly one in 140 UK"},{"startTime":2535.43,"endTime":2538.77,"body":"females will be diagnosed"},{"startTime":2538.77,"endTime":2541.51,"body":"with cervical cancer in"},{"startTime":2538.77,"endTime":2541.51,"body":"their lifetime at the moment."},{"startTime":2541.51,"endTime":2545.12,"body":"But for reasons I'll come"},{"startTime":2541.51,"endTime":2545.12,"body":"on to, this will change."},{"startTime":2545.12,"endTime":2548.724,"body":"Often, they will get their"},{"startTime":2545.12,"endTime":2548.724,"body":"cancer early in life."},{"startTime":2548.724,"endTime":2551.47,"body":"So this is the age distribution"},{"startTime":2548.724,"endTime":2551.47,"body":"on the right of this cancer."},{"startTime":2551.47,"endTime":2554.32,"body":"And because it's driven by"},{"startTime":2551.47,"endTime":2554.32,"body":"sexually transmitted infection"},{"startTime":2555.38,"endTime":2559.82,"body":"like the other STIs, it's"},{"startTime":2555.38,"endTime":2559.82,"body":"predominant in young adults,"},{"startTime":2559.82,"endTime":2561.76,"body":"very different from most cancers"},{"startTime":2561.76,"endTime":2564.053,"body":"which are in much older age,"},{"startTime":2565.02,"endTime":2568.78,"body":"it should by now really"},{"startTime":2565.02,"endTime":2568.78,"body":"be almost 100% preventable"},{"startTime":2568.78,"endTime":2572.52,"body":"by a combination of"},{"startTime":2568.78,"endTime":2572.52,"body":"vaccination and screening,"},{"startTime":2572.52,"endTime":2576.623,"body":"particularly in the young"},{"startTime":2572.52,"endTime":2576.623,"body":"cohorts coming through now."},{"startTime":2578.317,"endTime":2580.52,"body":"And the reason for that is that screening"},{"startTime":2580.52,"endTime":2582.89,"body":"has been really important"},{"startTime":2580.52,"endTime":2582.89,"body":"and will remain important."},{"startTime":2582.89,"endTime":2584.87,"body":"But the thing which is really"},{"startTime":2582.89,"endTime":2584.87,"body":"going to get on top of this"},{"startTime":2584.87,"endTime":2585.923,"body":"is vaccination."},{"startTime":2587.59,"endTime":2592.12,"body":"The vaccination for girls in"},{"startTime":2587.59,"endTime":2592.12,"body":"the UK against HPV 16 and 18,"},{"startTime":2592.12,"endTime":2595.84,"body":"which are the key ones"},{"startTime":2592.12,"endTime":2595.84,"body":"which drive most of the UK"},{"startTime":2595.84,"endTime":2598.753,"body":"cervical cancer was introduced in 2008."},{"startTime":2599.72,"endTime":2603.779,"body":"And since that time, these particular HPVs"},{"startTime":2603.779,"endTime":2607.658,"body":"the prevalence of them"},{"startTime":2603.779,"endTime":2607.658,"body":"in the young female,"},{"startTime":2607.658,"endTime":2612.27,"body":"adult female population"},{"startTime":2607.658,"endTime":2612.27,"body":"has really dropped away"},{"startTime":2612.27,"endTime":2613.663,"body":"very substantially."},{"startTime":2614.58,"endTime":2619.58,"body":"And the vaccine effectiveness"},{"startTime":2614.58,"endTime":2619.58,"body":"of these is over 80%,"},{"startTime":2619.96,"endTime":2623.552,"body":"not 100, but certainly over 80%."},{"startTime":2623.552,"endTime":2624.83,"body":"And what these graphs show"},{"startTime":2624.83,"endTime":2628.89,"body":"is that some of the key"},{"startTime":2624.83,"endTime":2628.89,"body":"HPVs that drive cancer"},{"startTime":2628.89,"endTime":2630.79,"body":"have decreased, but"},{"startTime":2628.89,"endTime":2630.79,"body":"the ones which actually"},{"startTime":2630.79,"endTime":2632.41,"body":"were irrelevant to cancer stay the same."},{"startTime":2632.41,"endTime":2634.28,"body":"So it's not a change in sexual behavior."},{"startTime":2634.28,"endTime":2636.643,"body":"It's because people are vaccinated."},{"startTime":2638.02,"endTime":2642.24,"body":"And what we know as of"},{"startTime":2638.02,"endTime":2642.24,"body":"just this last few months,"},{"startTime":2642.24,"endTime":2645.33,"body":"this paper was published very"},{"startTime":2642.24,"endTime":2645.33,"body":"recently in the Lancette."},{"startTime":2645.33,"endTime":2648.64,"body":"We now know that this is leading"},{"startTime":2645.33,"endTime":2648.64,"body":"to a substantial reduction"},{"startTime":2648.64,"endTime":2651.37,"body":"in cervical cancer risk in England."},{"startTime":2651.37,"endTime":2654.84,"body":"So very large study to"},{"startTime":2651.37,"endTime":2654.84,"body":"over 13 million years"},{"startTime":2654.84,"endTime":2658.35,"body":"of followup in people younger than age 30."},{"startTime":2658.35,"endTime":2659.98,"body":"And these are the cohorts."},{"startTime":2659.98,"endTime":2663.88,"body":"And in those who were in the youngest age"},{"startTime":2663.88,"endTime":2666.96,"body":"when they were vaccinated,"},{"startTime":2663.88,"endTime":2666.96,"body":"12 to 13 years old,"},{"startTime":2666.96,"endTime":2671.94,"body":"87% reduction, slightly"},{"startTime":2666.96,"endTime":2671.94,"body":"older age, 14 to 16,"},{"startTime":2671.94,"endTime":2674.37,"body":"still a substantial reduction,"},{"startTime":2671.94,"endTime":2674.37,"body":"very substantial reduction,"},{"startTime":2674.37,"endTime":2678.72,"body":"62% society lower, once"},{"startTime":2674.37,"endTime":2678.72,"body":"you get up to 16 to 18,"},{"startTime":2678.72,"endTime":2680.92,"body":"34% reduction,"},{"startTime":2680.92,"endTime":2683.89,"body":"what this shows is that"},{"startTime":2680.92,"endTime":2683.89,"body":"it's still worth doing,"},{"startTime":2683.89,"endTime":2686.54,"body":"but actually this is a virus"},{"startTime":2683.89,"endTime":2686.54,"body":"which people tend to acquire"},{"startTime":2686.54,"endTime":2690.06,"body":"extraordinarily early, in many cases."},{"startTime":2690.06,"endTime":2693.447,"body":"So HPV vaccine really important,"},{"startTime":2693.447,"endTime":2697.05,"body":"and this is over time, going"},{"startTime":2693.447,"endTime":2697.05,"body":"to lead to a massive fall away"},{"startTime":2697.05,"endTime":2699.553,"body":"in this important cancer of young women."},{"startTime":2701.78,"endTime":2703.47,"body":"And these vaccines are improving."},{"startTime":2703.47,"endTime":2707.49,"body":"So the number of HPVs they're"},{"startTime":2703.47,"endTime":2707.49,"body":"up against is getting wider."},{"startTime":2707.49,"endTime":2708.79,"body":"That will have a bigger effect"},{"startTime":2708.79,"endTime":2712.423,"body":"on some of the rarer HPVs causing cancer."},{"startTime":2713.37,"endTime":2715.6,"body":"The safety data is getting"},{"startTime":2713.37,"endTime":2715.6,"body":"stronger and stronger."},{"startTime":2715.6,"endTime":2718.835,"body":"These are very safe datas, vaccines."},{"startTime":2718.835,"endTime":2721.88,"body":"There's been an extension"},{"startTime":2718.835,"endTime":2721.88,"body":"of the vaccine to boys."},{"startTime":2721.88,"endTime":2725.37,"body":"This helps both boys who later"},{"startTime":2725.37,"endTime":2726.88,"body":"become men who have sex with men,"},{"startTime":2726.88,"endTime":2730.13,"body":"but also will help to"},{"startTime":2726.88,"endTime":2730.13,"body":"accelerate the reduction"},{"startTime":2730.13,"endTime":2732.24,"body":"in women, so it's got some big pluses."},{"startTime":2732.24,"endTime":2734.46,"body":"And in addition to cervical cancer,"},{"startTime":2734.46,"endTime":2739.46,"body":"HPV, sexually transmitted"},{"startTime":2734.46,"endTime":2739.46,"body":"can lead to vulva, penile,"},{"startTime":2739.54,"endTime":2743.101,"body":"anal cancers and some"},{"startTime":2739.54,"endTime":2743.101,"body":"mouse and throat cancers."},{"startTime":2743.101,"endTime":2745.41,"body":"So the vaccines will help"},{"startTime":2743.101,"endTime":2745.41,"body":"against all of these."},{"startTime":2745.41,"endTime":2747.47,"body":"And additionally, the new vaccines"},{"startTime":2747.47,"endTime":2749.89,"body":"are also protective against genital warts,"},{"startTime":2749.89,"endTime":2752.5,"body":"which cause as I say, a"},{"startTime":2749.89,"endTime":2752.5,"body":"lot of people distress."},{"startTime":2752.5,"endTime":2754.67,"body":"So multiple reasons to want people"},{"startTime":2754.67,"endTime":2757.523,"body":"to get vaccinated at as"},{"startTime":2754.67,"endTime":2757.523,"body":"early in age as possible."},{"startTime":2761.68,"endTime":2764.09,"body":"The other two infections,"},{"startTime":2764.09,"endTime":2766.26,"body":"which are particularly"},{"startTime":2764.09,"endTime":2766.26,"body":"associated with the cancers"},{"startTime":2766.26,"endTime":2769.0,"body":"that are passed on"},{"startTime":2766.26,"endTime":2769.0,"body":"sexually and bloodborne,"},{"startTime":2769.0,"endTime":2771.705,"body":"and in both cases, it's a bit of both,"},{"startTime":2771.705,"endTime":2776.705,"body":"are liver cancer due to"},{"startTime":2771.705,"endTime":2776.705,"body":"hepatitis B and hepatitis C."},{"startTime":2778.73,"endTime":2782.81,"body":"In many developing countries,"},{"startTime":2778.73,"endTime":2782.81,"body":"up to 90% of liver cancer,"},{"startTime":2782.81,"endTime":2785.71,"body":"also known as hepatoma and up to 40%"},{"startTime":2785.71,"endTime":2786.7,"body":"in some developed countries"},{"startTime":2786.7,"endTime":2790.43,"body":"is due to one or both"},{"startTime":2786.7,"endTime":2790.43,"body":"of these two viruses."},{"startTime":2790.43,"endTime":2791.5,"body":"And in some countries,"},{"startTime":2791.5,"endTime":2794.13,"body":"hepatoma is the most"},{"startTime":2791.5,"endTime":2794.13,"body":"common cancer that's there."},{"startTime":2794.13,"endTime":2796.54,"body":"Very high mortality, once"},{"startTime":2794.13,"endTime":2796.54,"body":"someone gets a cancer,"},{"startTime":2796.54,"endTime":2799.19,"body":"this is a scan of someone"},{"startTime":2796.54,"endTime":2799.19,"body":"with a cancer in the liver."},{"startTime":2799.19,"endTime":2800.07,"body":"Once they get it,"},{"startTime":2800.07,"endTime":2802.71,"body":"the mortality particularly"},{"startTime":2800.07,"endTime":2802.71,"body":"in lower income settings"},{"startTime":2802.71,"endTime":2803.853,"body":"is extremely high."},{"startTime":2805.99,"endTime":2810.43,"body":"Hepatitis B is both bloodborne and sexual."},{"startTime":2810.43,"endTime":2814.53,"body":"It's very common actually, easy to catch."},{"startTime":2814.53,"endTime":2817.08,"body":"So it's easier to"},{"startTime":2814.53,"endTime":2817.08,"body":"actually catch hepatitis B"},{"startTime":2817.08,"endTime":2820.21,"body":"in reality than it is for example HIV."},{"startTime":2820.21,"endTime":2823.36,"body":"WHO estimate that about 250"},{"startTime":2820.21,"endTime":2823.36,"body":"million people worldwide"},{"startTime":2823.36,"endTime":2826.38,"body":"are infected with this and the routes"},{"startTime":2826.38,"endTime":2829.06,"body":"of transmission interact with one another."},{"startTime":2829.06,"endTime":2833.153,"body":"But there are a combination"},{"startTime":2829.06,"endTime":2833.153,"body":"of sexual and blood to blood."},{"startTime":2834.34,"endTime":2837.93,"body":"In adults, it's sexually"},{"startTime":2834.34,"endTime":2837.93,"body":"transmitted between men and women,"},{"startTime":2837.93,"endTime":2840.05,"body":"men and men, women and women in theory,"},{"startTime":2840.05,"endTime":2842.28,"body":"but men and men, men and women."},{"startTime":2842.28,"endTime":2846.65,"body":"Intravenous drug use is"},{"startTime":2842.28,"endTime":2846.65,"body":"a secondary important"},{"startTime":2846.65,"endTime":2849.5,"body":"transmission route between"},{"startTime":2846.65,"endTime":2849.5,"body":"adults and in the UK,"},{"startTime":2849.5,"endTime":2852.15,"body":"it's certainly an important"},{"startTime":2849.5,"endTime":2852.15,"body":"part of the epidemiology."},{"startTime":2853.2,"endTime":2854.81,"body":"Then in many parts of the world,"},{"startTime":2854.81,"endTime":2857.16,"body":"particularly where it's not being treated,"},{"startTime":2857.16,"endTime":2859.32,"body":"there's vertical"},{"startTime":2857.16,"endTime":2859.32,"body":"transmission, mother to child."},{"startTime":2859.32,"endTime":2861.97,"body":"So a mother has hepatitis B,"},{"startTime":2861.97,"endTime":2864.38,"body":"she then transmits it to our child"},{"startTime":2864.38,"endTime":2867.11,"body":"and then the child has it."},{"startTime":2867.11,"endTime":2868.74,"body":"And then there's horizontal transmission"},{"startTime":2868.74,"endTime":2871.06,"body":"between children by just scrapping around"},{"startTime":2871.06,"endTime":2875.87,"body":"and blood to blood"},{"startTime":2871.06,"endTime":2875.87,"body":"contact in ordinary play."},{"startTime":2875.87,"endTime":2880.2,"body":"Most children will then get"},{"startTime":2875.87,"endTime":2880.2,"body":"it before the age of five."},{"startTime":2880.2,"endTime":2883.47,"body":"So that is the multiple routes"},{"startTime":2883.47,"endTime":2887.24,"body":"by which by combination of"},{"startTime":2883.47,"endTime":2887.24,"body":"blood and sexual transmission,"},{"startTime":2887.24,"endTime":2890.24,"body":"hepatitis B has become so common."},{"startTime":2890.24,"endTime":2892.04,"body":"There are some drugs to suppress it,"},{"startTime":2892.04,"endTime":2894.79,"body":"but there's certainly no drug"},{"startTime":2892.04,"endTime":2894.79,"body":"currently that is a cure."},{"startTime":2896.03,"endTime":2900.92,"body":"However, we do have highly"},{"startTime":2896.03,"endTime":2900.92,"body":"effective vaccines for this."},{"startTime":2900.92,"endTime":2905.84,"body":"And we know from quite"},{"startTime":2900.92,"endTime":2905.84,"body":"early vaccine programs"},{"startTime":2905.84,"endTime":2909.9,"body":"that hepatitis B can largely be got rid of"},{"startTime":2909.9,"endTime":2912.47,"body":"by hepatitis B vaccination."},{"startTime":2912.47,"endTime":2916.28,"body":"And this leads in due course"},{"startTime":2912.47,"endTime":2916.28,"body":"after a number of years,"},{"startTime":2916.28,"endTime":2919.333,"body":"to reduction in hepato cellular carcinoma."},{"startTime":2920.56,"endTime":2924.59,"body":"So it's significantly reduced"},{"startTime":2920.56,"endTime":2924.59,"body":"cancer incidents and mortality"},{"startTime":2924.59,"endTime":2927.98,"body":"first in Taiwan, where it"},{"startTime":2924.59,"endTime":2927.98,"body":"was studied fairly early on,"},{"startTime":2927.98,"endTime":2930.94,"body":"but now it's being rolled"},{"startTime":2927.98,"endTime":2930.94,"body":"out in most countries"},{"startTime":2930.94,"endTime":2933.03,"body":"in the world, including the UK,"},{"startTime":2933.03,"endTime":2935.73,"body":"usually as in a combination vaccine"},{"startTime":2935.73,"endTime":2938.8,"body":"with a number of other"},{"startTime":2935.73,"endTime":2938.8,"body":"really serious diseases."},{"startTime":2938.8,"endTime":2941.531,"body":"I provide somewhere between 95%"},{"startTime":2941.531,"endTime":2943.98,"body":"and 100% hepatitis B protection."},{"startTime":2943.98,"endTime":2945.51,"body":"The result of this is going to be"},{"startTime":2945.51,"endTime":2948.56,"body":"a very significant"},{"startTime":2945.51,"endTime":2948.56,"body":"reduction in this cancer,"},{"startTime":2948.56,"endTime":2950.81,"body":"which is passed on by combination"},{"startTime":2950.81,"endTime":2953.483,"body":"of sexual and bloodborne routes."},{"startTime":2955.76,"endTime":2959.56,"body":"Hepatitis C is more"},{"startTime":2955.76,"endTime":2959.56,"body":"bloodborne than sexual."},{"startTime":2959.56,"endTime":2962.44,"body":"The great majority now"},{"startTime":2959.56,"endTime":2962.44,"body":"is acquired in adults,"},{"startTime":2962.44,"endTime":2966.35,"body":"originally, historically"},{"startTime":2962.44,"endTime":2966.35,"body":"by unsafe medical practice,"},{"startTime":2966.35,"endTime":2968.511,"body":"including blood,"},{"startTime":2968.511,"endTime":2971.45,"body":"but now very much by intravenous drug use,"},{"startTime":2971.45,"endTime":2973.34,"body":"but there's also some"},{"startTime":2971.45,"endTime":2973.34,"body":"sexual spread as well."},{"startTime":2973.34,"endTime":2975.77,"body":"Although that's a lower risk in this case,"},{"startTime":2975.77,"endTime":2977.223,"body":"different from hepatitis B."},{"startTime":2978.17,"endTime":2983.17,"body":"Smaller number, but still"},{"startTime":2978.17,"endTime":2983.17,"body":"a very significant problem,"},{"startTime":2983.53,"endTime":2987.28,"body":"no vaccine for hepatitis C,"},{"startTime":2983.53,"endTime":2987.28,"body":"but in the last 10 years,"},{"startTime":2987.28,"endTime":2991.32,"body":"we have got now due to scientific work,"},{"startTime":2991.32,"endTime":2993.21,"body":"several highly effective oral drugs,"},{"startTime":2993.21,"endTime":2995.04,"body":"which lead to up to 90% cure rate."},{"startTime":2995.04,"endTime":2997.41,"body":"So in sense, the opposite way round"},{"startTime":2997.41,"endTime":3000.47,"body":"to hepatitis B and more like HIV."},{"startTime":3000.47,"endTime":3002.6,"body":"In fact, you can in fact cure people,"},{"startTime":3002.6,"endTime":3006.69,"body":"which is different from the"},{"startTime":3002.6,"endTime":3006.69,"body":"situation you find with HIV."},{"startTime":3006.69,"endTime":3008.545,"body":"So two important blood"},{"startTime":3008.545,"endTime":3012.12,"body":"and sexual infections driving cancer,"},{"startTime":3012.12,"endTime":3014.373,"body":"for which we have medical countermeasures."},{"startTime":3018.66,"endTime":3021.26,"body":"Switching onto the classical"},{"startTime":3021.26,"endTime":3024.78,"body":"kind of sexually transmitted infections."},{"startTime":3024.78,"endTime":3027.63,"body":"I just liked to go through"},{"startTime":3024.78,"endTime":3027.63,"body":"some of the more common ones,"},{"startTime":3027.63,"endTime":3031.293,"body":"because these are things which"},{"startTime":3027.63,"endTime":3031.293,"body":"are very common in society."},{"startTime":3032.48,"endTime":3034.37,"body":"Start off with gonorrhea,"},{"startTime":3034.37,"endTime":3036.83,"body":"much less serious than"},{"startTime":3034.37,"endTime":3036.83,"body":"HIV or untreated syphilis,"},{"startTime":3036.83,"endTime":3039.04,"body":"but very unpleasant, people describe it"},{"startTime":3039.04,"endTime":3040.75,"body":"like being peeing with razorblades"},{"startTime":3042.55,"endTime":3044.26,"body":"in people who've got symptoms"},{"startTime":3044.26,"endTime":3045.89,"body":"and sometimes can be serious."},{"startTime":3045.89,"endTime":3048.63,"body":"That can cause joint problems"},{"startTime":3045.89,"endTime":3048.63,"body":"of variety of other problems."},{"startTime":3048.63,"endTime":3050.25,"body":"It's particularly a problem"},{"startTime":3050.25,"endTime":3054.56,"body":"if people have gonorrhea in"},{"startTime":3050.25,"endTime":3054.56,"body":"pregnancy, it's quite common,"},{"startTime":3054.56,"endTime":3058.33,"body":"there are about 35,000"},{"startTime":3054.56,"endTime":3058.33,"body":"cases a year in the UK."},{"startTime":3058.33,"endTime":3060.23,"body":"It's the second most commonly reported"},{"startTime":3060.23,"endTime":3062.62,"body":"sexually transmitted infection."},{"startTime":3062.62,"endTime":3064.58,"body":"And I think two things"},{"startTime":3062.62,"endTime":3064.58,"body":"just to highlight with it,"},{"startTime":3064.58,"endTime":3066.5,"body":"the first of which is"},{"startTime":3064.58,"endTime":3066.5,"body":"it is very concentrated"},{"startTime":3066.5,"endTime":3068.0,"body":"where you find it."},{"startTime":3068.0,"endTime":3070.81,"body":"This is a map of the UK 2012 and 2017,"},{"startTime":3070.81,"endTime":3072.58,"body":"just showing the progression."},{"startTime":3072.58,"endTime":3074.57,"body":"It is growing at the moment,"},{"startTime":3074.57,"endTime":3077.08,"body":"but very highly concentrated in London."},{"startTime":3077.08,"endTime":3078.61,"body":"And indeed very close"},{"startTime":3078.61,"endTime":3080.44,"body":"to where I'm giving this lecture today."},{"startTime":3080.44,"endTime":3082.93,"body":"So it's particularly in urban settings,"},{"startTime":3082.93,"endTime":3085.2,"body":"but the other really big"},{"startTime":3082.93,"endTime":3085.2,"body":"problem we have with it"},{"startTime":3085.2,"endTime":3086.71,"body":"is that there are now"},{"startTime":3086.71,"endTime":3091.09,"body":"highly multi-drug resistant"},{"startTime":3086.71,"endTime":3091.09,"body":"forms of gonorrhea,"},{"startTime":3091.09,"endTime":3094.07,"body":"which ordinary antibiotic"},{"startTime":3091.09,"endTime":3094.07,"body":"classical treatment"},{"startTime":3094.07,"endTime":3094.903,"body":"for gonorrhea does not work for."},{"startTime":3094.903,"endTime":3096.34,"body":"And we are in fact,"},{"startTime":3096.34,"endTime":3097.173,"body":"potentially going to have to develop"},{"startTime":3097.173,"endTime":3099.43,"body":"new antibiotics for this problem."},{"startTime":3099.43,"endTime":3102.53,"body":"So there is a significant issue."},{"startTime":3102.53,"endTime":3105.86,"body":"It's getting bigger as in"},{"startTime":3102.53,"endTime":3105.86,"body":"terms of the numbers of cases,"},{"startTime":3105.86,"endTime":3107.71,"body":"and it's getting more drug resistant,"},{"startTime":3109.7,"endTime":3111.6,"body":"important to highlight the complications."},{"startTime":3111.6,"endTime":3113.94,"body":"If people still have"},{"startTime":3111.6,"endTime":3113.94,"body":"gonorrhea at the point"},{"startTime":3114.91,"endTime":3119.313,"body":"they are in pregnancy, at"},{"startTime":3114.91,"endTime":3119.313,"body":"both the fore end and during,"},{"startTime":3120.24,"endTime":3121.15,"body":"if women have gonorrhea,"},{"startTime":3121.15,"endTime":3123.56,"body":"they can get pelvic inflammatory disease."},{"startTime":3123.56,"endTime":3126.11,"body":"And this can reduce fertility."},{"startTime":3126.11,"endTime":3130.42,"body":"In pregnancy, it can cause"},{"startTime":3126.11,"endTime":3130.42,"body":"a preventable miscarriage"},{"startTime":3130.42,"endTime":3132.55,"body":"could have been prevented by treatment"},{"startTime":3132.55,"endTime":3134.65,"body":"and can lead to premature labor."},{"startTime":3134.65,"endTime":3138.053,"body":"And if children are born,"},{"startTime":3134.65,"endTime":3138.053,"body":"when a woman is infected,"},{"startTime":3138.92,"endTime":3141.04,"body":"they can get infections in particular"},{"startTime":3141.04,"endTime":3142.89,"body":"and dangerously of their eyes."},{"startTime":3142.89,"endTime":3147.09,"body":"So almost a third of babies"},{"startTime":3142.89,"endTime":3147.09,"body":"born to infected mothers"},{"startTime":3147.09,"endTime":3149.62,"body":"will get this potentially"},{"startTime":3147.09,"endTime":3149.62,"body":"blinding complication"},{"startTime":3149.62,"endTime":3151.657,"body":"that needs to be treated very rapidly,"},{"startTime":3151.657,"endTime":3153.303,"body":"that you can see on the right."},{"startTime":3156.84,"endTime":3157.7,"body":"As I showed on the maps,"},{"startTime":3157.7,"endTime":3159.666,"body":"the gonorrhea diagnoses are increasing"},{"startTime":3159.666,"endTime":3162.56,"body":"in both men and women, both heterosexual"},{"startTime":3162.56,"endTime":3165.4,"body":"and men who have sex with men,"},{"startTime":3165.4,"endTime":3167.74,"body":"but particularly men"},{"startTime":3165.4,"endTime":3167.74,"body":"who have sex with men."},{"startTime":3167.74,"endTime":3170.35,"body":"And it's been increasing"},{"startTime":3167.74,"endTime":3170.35,"body":"over the last several years,"},{"startTime":3170.35,"endTime":3172.63,"body":"arguably because people are"},{"startTime":3170.35,"endTime":3172.63,"body":"taking fewer precautions"},{"startTime":3172.63,"endTime":3174.723,"body":"as HIV has become less of a risk."},{"startTime":3178.81,"endTime":3182.03,"body":"Another disease, which got"},{"startTime":3178.81,"endTime":3182.03,"body":"quite a lot of similarities"},{"startTime":3182.03,"endTime":3183.75,"body":"symptomatically though"},{"startTime":3182.03,"endTime":3183.75,"body":"it's very different disease"},{"startTime":3183.75,"endTime":3186.21,"body":"in terms of the biology is chlamydia."},{"startTime":3186.21,"endTime":3189.67,"body":"It's a very common bacterial"},{"startTime":3186.21,"endTime":3189.67,"body":"sexually transmitted infection,"},{"startTime":3189.67,"endTime":3192.26,"body":"it's treatable again with antibiotics."},{"startTime":3192.26,"endTime":3194.0,"body":"Again, importantly, you got to treat both"},{"startTime":3194.0,"endTime":3195.653,"body":"partners at the same time."},{"startTime":3196.95,"endTime":3199.08,"body":"Over 70% of people who've got chlamydia"},{"startTime":3199.08,"endTime":3201.65,"body":"notice no symptoms at all."},{"startTime":3201.65,"endTime":3204.53,"body":"And this means they might have two or more"},{"startTime":3204.53,"endTime":3207.393,"body":"sexual relationships between"},{"startTime":3204.53,"endTime":3207.393,"body":"the time they get infected."},{"startTime":3208.526,"endTime":3209.76,"body":"And the time they actually meet someone"},{"startTime":3209.76,"endTime":3211.41,"body":"who then goes on to have symptoms,"},{"startTime":3211.41,"endTime":3213.23,"body":"they may be totally unaware of the fact"},{"startTime":3213.23,"endTime":3214.753,"body":"they have it over many years."},{"startTime":3215.639,"endTime":3217.06,"body":"And those do have symptoms"},{"startTime":3217.06,"endTime":3221.13,"body":"tend to notice pain on"},{"startTime":3217.06,"endTime":3221.13,"body":"urination, pain having sex"},{"startTime":3221.13,"endTime":3224.54,"body":"or bleeding after it,"},{"startTime":3221.13,"endTime":3224.54,"body":"bleeding between periods"},{"startTime":3224.54,"endTime":3225.89,"body":"and lower abdominal pain."},{"startTime":3225.89,"endTime":3229.493,"body":"And any of these can be pretty"},{"startTime":3225.89,"endTime":3229.493,"body":"classical for chlamydia."},{"startTime":3231.1,"endTime":3233.043,"body":"Age tends to be younger adults."},{"startTime":3234.58,"endTime":3238.5,"body":"And it's more commonly"},{"startTime":3234.58,"endTime":3238.5,"body":"diagnosed in men and women,"},{"startTime":3238.5,"endTime":3242.597,"body":"but that's probably largely"},{"startTime":3238.5,"endTime":3242.597,"body":"to do is the number of people"},{"startTime":3242.597,"endTime":3244.823,"body":"who are symptomatic and seek a treatment."},{"startTime":3247.5,"endTime":3248.9,"body":"It is like gonorrhea,"},{"startTime":3248.9,"endTime":3253.1,"body":"important to identify and"},{"startTime":3248.9,"endTime":3253.1,"body":"treat chlamydia in women."},{"startTime":3253.1,"endTime":3255.9,"body":"And it can again, cause"},{"startTime":3253.1,"endTime":3255.9,"body":"pelvic inflammatory disease"},{"startTime":3255.9,"endTime":3257.986,"body":"and therefore have issues"},{"startTime":3257.986,"endTime":3260.56,"body":"with infertility or ectopic pregnancies."},{"startTime":3260.56,"endTime":3262.73,"body":"And again, if infected in childbirth,"},{"startTime":3262.73,"endTime":3265.103,"body":"they can cause problems"},{"startTime":3262.73,"endTime":3265.103,"body":"in the eyes of the baby"},{"startTime":3265.103,"endTime":3266.55,"body":"or pneumonia."},{"startTime":3266.55,"endTime":3268.68,"body":"'Cause chlamydia. is one of the causes"},{"startTime":3268.68,"endTime":3270.33,"body":"of an atypical form of pneumonia."},{"startTime":3271.19,"endTime":3274.61,"body":"Men can cause inflammation"},{"startTime":3271.19,"endTime":3274.61,"body":"particularly around"},{"startTime":3276.859,"endTime":3279.23,"body":"the testes and can affect fertility,"},{"startTime":3279.23,"endTime":3281.23,"body":"though, to a lesser extent."},{"startTime":3281.23,"endTime":3284.23,"body":"And men also, and much"},{"startTime":3281.23,"endTime":3284.23,"body":"smaller number of women."},{"startTime":3284.23,"endTime":3287.93,"body":"Men also can get a very"},{"startTime":3284.23,"endTime":3287.93,"body":"unpleasant arthritis"},{"startTime":3287.93,"endTime":3291.37,"body":"for weeks to months after the infection."},{"startTime":3291.37,"endTime":3294.0,"body":"This is an immune response really,"},{"startTime":3294.0,"endTime":3297.73,"body":"and that can also cause"},{"startTime":3294.0,"endTime":3297.73,"body":"them significant disability."},{"startTime":3297.73,"endTime":3299.354,"body":"So it's not a trivial disease"},{"startTime":3299.354,"endTime":3301.733,"body":"in those people who do get symptoms."},{"startTime":3304.15,"endTime":3306.233,"body":"And the third in this"},{"startTime":3304.15,"endTime":3306.233,"body":"kind of group of diseases"},{"startTime":3306.233,"endTime":3310.09,"body":"that have got some similarities"},{"startTime":3306.233,"endTime":3310.09,"body":"is a parasitic disease"},{"startTime":3310.09,"endTime":3312.58,"body":"trichomonas, on the right here."},{"startTime":3312.58,"endTime":3314.9,"body":"Again, very common, treatable,"},{"startTime":3314.9,"endTime":3317.665,"body":"is a parasitic sexually"},{"startTime":3314.9,"endTime":3317.665,"body":"transmitted infection."},{"startTime":3317.665,"endTime":3321.84,"body":"Again, only about 30% of people"},{"startTime":3317.665,"endTime":3321.84,"body":"who have it have symptoms."},{"startTime":3321.84,"endTime":3325.56,"body":"And those are do it's itching,"},{"startTime":3321.84,"endTime":3325.56,"body":"inflammation, discharge,"},{"startTime":3325.56,"endTime":3327.183,"body":"and pain on having sex."},{"startTime":3328.58,"endTime":3332.35,"body":"It can cause preterm birth"},{"startTime":3328.58,"endTime":3332.35,"body":"in infected pregnant women"},{"startTime":3332.35,"endTime":3333.77,"body":"and like some of the others,"},{"startTime":3333.77,"endTime":3335.43,"body":"'cause of the fact that someone's got"},{"startTime":3335.43,"endTime":3337.13,"body":"an inflamed genital area,"},{"startTime":3337.13,"endTime":3340.46,"body":"it increases the risk"},{"startTime":3337.13,"endTime":3340.46,"body":"of HIV is being spread,"},{"startTime":3340.46,"endTime":3344.33,"body":"relatively easy to treat"},{"startTime":3340.46,"endTime":3344.33,"body":"once it has been diagnosed."},{"startTime":3344.33,"endTime":3346.62,"body":"So with all of these screening for them,"},{"startTime":3346.62,"endTime":3351.62,"body":"if people have had higher"},{"startTime":3346.62,"endTime":3351.62,"body":"risk on new sexual contact,"},{"startTime":3353.02,"endTime":3354.27,"body":"even if they don't have symptoms"},{"startTime":3354.27,"endTime":3356.5,"body":"'cause remembering a lot"},{"startTime":3354.27,"endTime":3356.5,"body":"people don't have symptoms"},{"startTime":3356.5,"endTime":3360.24,"body":"and taking any symptoms,"},{"startTime":3356.5,"endTime":3360.24,"body":"however trivial seriously,"},{"startTime":3360.24,"endTime":3364.863,"body":"because these are easy to treat"},{"startTime":3360.24,"endTime":3364.863,"body":"and important if untreated."},{"startTime":3369.3,"endTime":3371.8,"body":"Finally in this group of more classical"},{"startTime":3371.8,"endTime":3374.162,"body":"sexually transmitted infections,"},{"startTime":3374.162,"endTime":3376.34,"body":"one which presents rather differently"},{"startTime":3376.34,"endTime":3378.403,"body":"from the last three herpes."},{"startTime":3379.55,"endTime":3382.9,"body":"There are two main forms"},{"startTime":3379.55,"endTime":3382.9,"body":"of herpes, simplex,"},{"startTime":3382.9,"endTime":3384.45,"body":"herpes simplex virus one,"},{"startTime":3384.45,"endTime":3387.05,"body":"which is the cause of oral cold sores."},{"startTime":3387.05,"endTime":3389.44,"body":"It's not generally sexually"},{"startTime":3387.05,"endTime":3389.44,"body":"transmitted although it can be,"},{"startTime":3389.44,"endTime":3392.49,"body":"can be transmitted orally to genitally."},{"startTime":3392.49,"endTime":3395.18,"body":"But most people just have it on the lips."},{"startTime":3395.18,"endTime":3397.197,"body":"It's extremely common, and"},{"startTime":3395.18,"endTime":3397.197,"body":"as anyone who's got it."},{"startTime":3397.197,"endTime":3398.81,"body":"And a lot of people who are watching this"},{"startTime":3398.81,"endTime":3401.71,"body":"will have had colddsores of the lips."},{"startTime":3401.71,"endTime":3403.646,"body":"What you find is you have these,"},{"startTime":3403.646,"endTime":3408.22,"body":"these sort of bumbly eruptions"},{"startTime":3403.646,"endTime":3408.22,"body":"that occur on the lip,"},{"startTime":3408.22,"endTime":3410.44,"body":"usually in the same"},{"startTime":3408.22,"endTime":3410.44,"body":"place and it breaks down"},{"startTime":3410.44,"endTime":3412.52,"body":"to an ulcer and then it goes away"},{"startTime":3412.52,"endTime":3415.59,"body":"because it's hiding in the"},{"startTime":3412.52,"endTime":3415.59,"body":"nerves and then it comes back,"},{"startTime":3415.59,"endTime":3418.873,"body":"particularly if there's trauma"},{"startTime":3415.59,"endTime":3418.873,"body":"or a variety of other things,"},{"startTime":3420.38,"endTime":3421.71,"body":"people tend to acquire it in childhood"},{"startTime":3421.71,"endTime":3423.41,"body":"and then they'll have it lifelong."},{"startTime":3424.77,"endTime":3428.98,"body":"HSV two, which is the much"},{"startTime":3424.77,"endTime":3428.98,"body":"more common sexual form,"},{"startTime":3428.98,"endTime":3432.003,"body":"is very similar, but it's in the genitals."},{"startTime":3432.87,"endTime":3434.77,"body":"Estimated that there's just short"},{"startTime":3434.77,"endTime":3438.32,"body":"of 500 million people have it worldwide."},{"startTime":3438.32,"endTime":3440.28,"body":"The UK has got significant rates"},{"startTime":3440.28,"endTime":3441.38,"body":"although lower than the USA,"},{"startTime":3441.38,"endTime":3444.053,"body":"where a lot of the research"},{"startTime":3441.38,"endTime":3444.053,"body":"has been done on it."},{"startTime":3446.21,"endTime":3447.94,"body":"It's really similar to the cold sore"},{"startTime":3447.94,"endTime":3450.03,"body":"in that you get an initial lesion,"},{"startTime":3450.03,"endTime":3454.5,"body":"then it gets better and"},{"startTime":3450.03,"endTime":3454.5,"body":"then it can come back again"},{"startTime":3454.5,"endTime":3456.67,"body":"multiple times during life."},{"startTime":3456.67,"endTime":3458.53,"body":"The first time someone gets it,"},{"startTime":3458.53,"endTime":3460.63,"body":"the primary infection can be very painful,"},{"startTime":3461.54,"endTime":3463.68,"body":"but often people have no symptoms"},{"startTime":3463.68,"endTime":3465.87,"body":"or just have an itching and painful ulcer"},{"startTime":3465.87,"endTime":3468.42,"body":"which people really don't"},{"startTime":3465.87,"endTime":3468.42,"body":"think a huge amount about,"},{"startTime":3468.42,"endTime":3469.86,"body":"but then it can recur through life,"},{"startTime":3469.86,"endTime":3471.39,"body":"sometimes with no symptoms at all."},{"startTime":3471.39,"endTime":3473.38,"body":"But with when it does recur,"},{"startTime":3473.38,"endTime":3475.45,"body":"someone is spreading the virus"},{"startTime":3475.45,"endTime":3478.73,"body":"potentially infecting any partner,"},{"startTime":3478.73,"endTime":3480.68,"body":"sexual partner they have at that stage."},{"startTime":3482.47,"endTime":3484.7,"body":"And that's important because"},{"startTime":3482.47,"endTime":3484.7,"body":"there's no cure for this."},{"startTime":3484.7,"endTime":3486.41,"body":"And currently no vaccine,"},{"startTime":3486.41,"endTime":3489.62,"body":"although drugs can"},{"startTime":3486.41,"endTime":3489.62,"body":"reduce both the frequency"},{"startTime":3489.62,"endTime":3491.23,"body":"and the severity."},{"startTime":3491.23,"endTime":3493.3,"body":"And actually one of the biggest impacts"},{"startTime":3493.3,"endTime":3494.81,"body":"that this infection can have"},{"startTime":3494.81,"endTime":3496.98,"body":"is on relationships because"},{"startTime":3494.81,"endTime":3496.98,"body":"once someone's infected"},{"startTime":3496.98,"endTime":3498.27,"body":"often in early life,"},{"startTime":3498.27,"endTime":3501.08,"body":"they know that there is"},{"startTime":3498.27,"endTime":3501.08,"body":"a reasonably high chance"},{"startTime":3501.08,"endTime":3503.38,"body":"they may infect any"},{"startTime":3501.08,"endTime":3503.38,"body":"subsequent sexual partner,"},{"startTime":3503.38,"endTime":3504.71,"body":"'cause it's not going to go away."},{"startTime":3504.71,"endTime":3508.71,"body":"Can't treat it like the previous"},{"startTime":3504.71,"endTime":3508.71,"body":"ones and it can come back"},{"startTime":3508.71,"endTime":3511.67,"body":"largely an known or unprovoked"},{"startTime":3511.67,"endTime":3513.31,"body":"and infect a subsequent partner."},{"startTime":3513.31,"endTime":3514.95,"body":"So it is something which can have"},{"startTime":3514.95,"endTime":3518.251,"body":"really quite important"},{"startTime":3514.95,"endTime":3518.251,"body":"impacts on people's romantic,"},{"startTime":3518.251,"endTime":3521.15,"body":"emotional, sexual lives."},{"startTime":3521.15,"endTime":3524.093,"body":"And cause relationship concerns."},{"startTime":3528.34,"endTime":3529.94,"body":"Finally a slightly different one."},{"startTime":3529.94,"endTime":3530.944,"body":"And they have not gone through"},{"startTime":3530.944,"endTime":3531.777,"body":"all the sexually transmitted infections."},{"startTime":3531.777,"endTime":3532.91,"body":"There are quite a few others,"},{"startTime":3532.91,"endTime":3537.91,"body":"but one that is not in"},{"startTime":3532.91,"endTime":3537.91,"body":"the genitals themselves,"},{"startTime":3538.29,"endTime":3539.89,"body":"but around them, pubic lice,"},{"startTime":3539.89,"endTime":3540.91,"body":"also known as crabs"},{"startTime":3540.91,"endTime":3542.77,"body":"for reasons that are really fairly obvious"},{"startTime":3542.77,"endTime":3546.38,"body":"if you look at them under a"},{"startTime":3542.77,"endTime":3546.38,"body":"microscope as in this case."},{"startTime":3546.38,"endTime":3548.75,"body":"They're not dangerous, they"},{"startTime":3546.38,"endTime":3548.75,"body":"don't spread any diseases."},{"startTime":3548.75,"endTime":3550.24,"body":"They just cause some itching."},{"startTime":3550.24,"endTime":3554.67,"body":"Particularly if people are"},{"startTime":3550.24,"endTime":3554.67,"body":"allergic to louse saliva,"},{"startTime":3554.67,"endTime":3557.49,"body":"and they've evolved to live in pubic hair,"},{"startTime":3557.49,"endTime":3559.66,"body":"that's naturally where they live."},{"startTime":3559.66,"endTime":3562.13,"body":"They can occasionally live on other areas"},{"startTime":3562.13,"endTime":3565.5,"body":"with sparse thicker hair on the body,"},{"startTime":3565.5,"endTime":3567.8,"body":"occasionally eyebrows, but not scalp hair."},{"startTime":3567.8,"endTime":3572.04,"body":"So head lice, knits and so"},{"startTime":3567.8,"endTime":3572.04,"body":"on are completely different."},{"startTime":3572.04,"endTime":3573.49,"body":"And if you can see head lice,"},{"startTime":3573.49,"endTime":3577.09,"body":"they're not sexually transmitted,"},{"startTime":3573.49,"endTime":3577.09,"body":"it's not going to happen."},{"startTime":3577.09,"endTime":3579.98,"body":"You know, it doesn't"},{"startTime":3577.09,"endTime":3579.98,"body":"go in either direction."},{"startTime":3579.98,"endTime":3581.94,"body":"They spread person to"},{"startTime":3579.98,"endTime":3581.94,"body":"person, and of course,"},{"startTime":3581.94,"endTime":3585.01,"body":"unlike many of the other"},{"startTime":3581.94,"endTime":3585.01,"body":"sexually transmitted infections,"},{"startTime":3585.01,"endTime":3586.35,"body":"condoms are not going to stop them"},{"startTime":3586.35,"endTime":3588.59,"body":"'cause they're not"},{"startTime":3586.35,"endTime":3588.59,"body":"actually on the genitals,"},{"startTime":3588.59,"endTime":3590.23,"body":"they're in the hair around it."},{"startTime":3590.23,"endTime":3593.33,"body":"They're only able to live for"},{"startTime":3590.23,"endTime":3593.33,"body":"a very short time off humans."},{"startTime":3593.33,"endTime":3595.07,"body":"So they tend to be human to human."},{"startTime":3595.07,"endTime":3597.42,"body":"And they're extremely easy"},{"startTime":3595.07,"endTime":3597.42,"body":"to treat once diagnosed."},{"startTime":3597.42,"endTime":3599.51,"body":"If you get itching, just think about it."},{"startTime":3599.51,"endTime":3601.833,"body":"Treatments are really"},{"startTime":3599.51,"endTime":3601.833,"body":"very straightforward."},{"startTime":3605.29,"endTime":3608.33,"body":"Finally before I just run down"},{"startTime":3605.29,"endTime":3608.33,"body":"on some of the epidemiology,"},{"startTime":3608.33,"endTime":3613.2,"body":"just worth noting that many"},{"startTime":3608.33,"endTime":3613.2,"body":"important diseases have a rare,"},{"startTime":3613.2,"endTime":3616.41,"body":"but sometimes important"},{"startTime":3613.2,"endTime":3616.41,"body":"additional sexual spread"},{"startTime":3616.41,"endTime":3619.54,"body":"in addition to their main"},{"startTime":3616.41,"endTime":3619.54,"body":"route of transmission."},{"startTime":3619.54,"endTime":3623.163,"body":"And I'll give two recent"},{"startTime":3619.54,"endTime":3623.163,"body":"examples, Ebola and Zika."},{"startTime":3624.01,"endTime":3627.25,"body":"And what with both of these"},{"startTime":3624.01,"endTime":3627.25,"body":"we have is a very prolonged"},{"startTime":3627.25,"endTime":3631.59,"body":"persistence of the virus"},{"startTime":3627.25,"endTime":3631.59,"body":"for months, in some cases"},{"startTime":3631.59,"endTime":3634.83,"body":"in the male reproductive"},{"startTime":3631.59,"endTime":3634.83,"body":"tract and the seminal fluid"},{"startTime":3634.83,"endTime":3637.53,"body":"that comes from that from Ebola,"},{"startTime":3637.53,"endTime":3638.93,"body":"which is a disease of touch."},{"startTime":3638.93,"endTime":3641.11,"body":"I'll come onto that later, and Zika,"},{"startTime":3641.11,"endTime":3642.54,"body":"which is a vector-borne disease,"},{"startTime":3642.54,"endTime":3645.503,"body":"which I talked about in the"},{"startTime":3642.54,"endTime":3645.503,"body":"first lecture in this series."},{"startTime":3646.57,"endTime":3650.29,"body":"And this can stay in"},{"startTime":3646.57,"endTime":3650.29,"body":"the male genital tract"},{"startTime":3650.29,"endTime":3653.79,"body":"for months after the"},{"startTime":3650.29,"endTime":3653.79,"body":"man has recovered fully."},{"startTime":3653.79,"endTime":3655.52,"body":"And if you test their blood,"},{"startTime":3655.52,"endTime":3657.81,"body":"the virus has gone away completely"},{"startTime":3657.81,"endTime":3659.34,"body":"and they allow the infection therefore,"},{"startTime":3659.34,"endTime":3661.5,"body":"to be reintroduced into a society."},{"startTime":3661.5,"endTime":3664.12,"body":"If the epidemic has gone away,"},{"startTime":3664.12,"endTime":3666.05,"body":"they can reintroduce the epidemic"},{"startTime":3666.05,"endTime":3669.68,"body":"long after initial infection,"},{"startTime":3666.05,"endTime":3669.68,"body":"and indeed over some space,"},{"startTime":3669.68,"endTime":3671.68,"body":"you could have a situation"},{"startTime":3669.68,"endTime":3671.68,"body":"where someone, for example,"},{"startTime":3671.68,"endTime":3673.492,"body":"picked up Zika in Brazil,"},{"startTime":3673.492,"endTime":3677.96,"body":"but infected their female"},{"startTime":3673.492,"endTime":3677.96,"body":"partner some weeks later"},{"startTime":3677.96,"endTime":3680.4,"body":"in the USA, so it's a mechanism by which,"},{"startTime":3680.4,"endTime":3683.61,"body":"even though it's a rare transmission route"},{"startTime":3683.61,"endTime":3684.66,"body":"for this particular virus,"},{"startTime":3684.66,"endTime":3687.31,"body":"something can be transmitted over time."},{"startTime":3687.31,"endTime":3688.8,"body":"'Cause it's over many months"},{"startTime":3688.8,"endTime":3691.743,"body":"rather than they were just"},{"startTime":3688.8,"endTime":3691.743,"body":"a few days and over space."},{"startTime":3694.64,"endTime":3696.3,"body":"Finally, just a little"},{"startTime":3694.64,"endTime":3696.3,"body":"bit on the epidemiology"},{"startTime":3696.3,"endTime":3699.443,"body":"of sexually transmitted"},{"startTime":3696.3,"endTime":3699.443,"body":"diseases in the UK,"},{"startTime":3700.43,"endTime":3703.65,"body":"they are highly clustered in urban areas,"},{"startTime":3703.65,"endTime":3706.04,"body":"particularly in the UK, in London,"},{"startTime":3706.04,"endTime":3707.95,"body":"but also in the other big urban areas"},{"startTime":3707.95,"endTime":3709.83,"body":"and particularly unsurprisingly"},{"startTime":3709.83,"endTime":3712.863,"body":"in areas where there are"},{"startTime":3709.83,"endTime":3712.863,"body":"large numbers of young adults,"},{"startTime":3714.23,"endTime":3717.35,"body":"areas of higher education,"},{"startTime":3714.23,"endTime":3717.35,"body":"early work and so on."},{"startTime":3717.35,"endTime":3720.14,"body":"Big innovations tend to"},{"startTime":3717.35,"endTime":3720.14,"body":"be where young adults live"},{"startTime":3720.14,"endTime":3720.99,"body":"that therefore tends to be"},{"startTime":3720.99,"endTime":3723.14,"body":"where sexually transmitted"},{"startTime":3720.99,"endTime":3723.14,"body":"infections live."},{"startTime":3724.03,"endTime":3727.17,"body":"And what you see on the left here"},{"startTime":3727.17,"endTime":3730.64,"body":"is a graph where all"},{"startTime":3727.17,"endTime":3730.64,"body":"the things colored red"},{"startTime":3730.64,"endTime":3733.61,"body":"in terms of the proportion"},{"startTime":3730.64,"endTime":3733.61,"body":"of people infected."},{"startTime":3733.61,"endTime":3734.85,"body":"All of those are in London."},{"startTime":3734.85,"endTime":3738.513,"body":"You can see a really heavy"},{"startTime":3734.85,"endTime":3738.513,"body":"concentration of STIs in London."},{"startTime":3741.17,"endTime":3743.12,"body":"In terms of what's happening over time."},{"startTime":3743.12,"endTime":3745.772,"body":"Some are good at going"},{"startTime":3743.12,"endTime":3745.772,"body":"away, in particular,"},{"startTime":3745.772,"endTime":3750.772,"body":"hepatitis B and anything"},{"startTime":3745.772,"endTime":3750.772,"body":"associated with HPV,"},{"startTime":3754.42,"endTime":3756.82,"body":"importantly, cervical cancer,"},{"startTime":3754.42,"endTime":3756.82,"body":"but increasingly warts."},{"startTime":3756.82,"endTime":3758.29,"body":"And what you can see these green lines"},{"startTime":3758.29,"endTime":3761.37,"body":"in men on the left and women on the right,"},{"startTime":3761.37,"endTime":3762.72,"body":"is the green line's going down."},{"startTime":3762.72,"endTime":3763.95,"body":"And they will continue to go down"},{"startTime":3763.95,"endTime":3765.74,"body":"because of vaccination programs."},{"startTime":3765.74,"endTime":3767.4,"body":"Some are on the other hand going up"},{"startTime":3767.4,"endTime":3770.86,"body":"and an important one"},{"startTime":3767.4,"endTime":3770.86,"body":"on these is gonorrhea,"},{"startTime":3770.86,"endTime":3773.2,"body":"which is increasing particularly in men,"},{"startTime":3773.2,"endTime":3775.39,"body":"and some are relatively low,"},{"startTime":3775.39,"endTime":3777.92,"body":"but increasing slightly"},{"startTime":3775.39,"endTime":3777.92,"body":"including syphilis."},{"startTime":3777.92,"endTime":3782.13,"body":"So over time there are changes"},{"startTime":3777.92,"endTime":3782.13,"body":"in the epidemiology of STIs."},{"startTime":3782.13,"endTime":3784.18,"body":"Really it's the ones with"},{"startTime":3782.13,"endTime":3784.18,"body":"which we have got vaccination"},{"startTime":3784.18,"endTime":3786.84,"body":"or treatment where the"},{"startTime":3784.18,"endTime":3786.84,"body":"rates are going down."},{"startTime":3786.84,"endTime":3789.913,"body":"The ones that depend on behaviors less so."},{"startTime":3791.52,"endTime":3792.423,"body":"So in summary,"},{"startTime":3794.45,"endTime":3795.85,"body":"when we consider sexually transmitted"},{"startTime":3795.85,"endTime":3798.65,"body":"and bloodborne infections,"},{"startTime":3795.85,"endTime":3798.65,"body":"some of them are very common."},{"startTime":3799.803,"endTime":3801.633,"body":"Some of them are life-threatening."},{"startTime":3802.71,"endTime":3804.45,"body":"Early diagnosis and treatment"},{"startTime":3804.45,"endTime":3805.76,"body":"is essential for all of them,"},{"startTime":3805.76,"endTime":3808.5,"body":"whether serious or generally more trivial,"},{"startTime":3808.5,"endTime":3812.25,"body":"but could be for example, a"},{"startTime":3808.5,"endTime":3812.25,"body":"risk to fertility or pregnancy."},{"startTime":3812.25,"endTime":3814.39,"body":"It's really important"},{"startTime":3812.25,"endTime":3814.39,"body":"to de-stigmatize these."},{"startTime":3814.39,"endTime":3816.05,"body":"And just talk about"},{"startTime":3814.39,"endTime":3816.05,"body":"them in an ordinary way."},{"startTime":3816.05,"endTime":3817.87,"body":"These are just an"},{"startTime":3816.05,"endTime":3817.87,"body":"infection that is passed on"},{"startTime":3817.87,"endTime":3821.423,"body":"by route of infection, which is sexual."},{"startTime":3823.22,"endTime":3827.47,"body":"HIV, syphilis and hepatitis"},{"startTime":3823.22,"endTime":3827.47,"body":"C have been transformed"},{"startTime":3827.47,"endTime":3828.67,"body":"by treatment."},{"startTime":3828.67,"endTime":3829.88,"body":"The medical science on this"},{"startTime":3829.88,"endTime":3832.33,"body":"has been absolutely transformational."},{"startTime":3832.33,"endTime":3837.33,"body":"And in the case of HPV,"},{"startTime":3832.33,"endTime":3837.33,"body":"cervical cancer and hepatitis B,"},{"startTime":3837.35,"endTime":3838.25,"body":"we've got vaccines,"},{"startTime":3838.25,"endTime":3839.96,"body":"which will have a very major impact"},{"startTime":3839.96,"endTime":3841.12,"body":"on those cancers over time."},{"startTime":3841.12,"endTime":3845.13,"body":"So there are some really"},{"startTime":3841.12,"endTime":3845.13,"body":"good forward movements"},{"startTime":3845.13,"endTime":3848.88,"body":"for these really serious"},{"startTime":3845.13,"endTime":3848.88,"body":"sexually transmitted infections"},{"startTime":3848.88,"endTime":3852.509,"body":"and looking, turning"},{"startTime":3848.88,"endTime":3852.509,"body":"to the blood born ones,"},{"startTime":3852.509,"endTime":3855.345,"body":"safe blood products, much"},{"startTime":3852.509,"endTime":3855.345,"body":"safer medical practice"},{"startTime":3855.345,"endTime":3858.28,"body":"means that side of transmission"},{"startTime":3858.28,"endTime":3860.0,"body":"has really almost entirely gone away,"},{"startTime":3860.0,"endTime":3862.7,"body":"at least in higher and"},{"startTime":3860.0,"endTime":3862.7,"body":"middle income countries"},{"startTime":3862.7,"endTime":3866.45,"body":"and initiatives such as needle exchanges"},{"startTime":3866.45,"endTime":3869.267,"body":"can be important for those who are people"},{"startTime":3869.267,"endTime":3871.663,"body":"who use intravenous drugs recreationally."},{"startTime":3872.535,"endTime":3874.57,"body":"Many things getting better,"},{"startTime":3874.57,"endTime":3878.13,"body":"but sexually transmitted"},{"startTime":3874.57,"endTime":3878.13,"body":"infections will always be with us."},{"startTime":3878.13,"endTime":3879.363,"body":"Thank you very much."}]}