The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS by Elizabeth Pisani
In her exceptionally candid, accessible, and fascinating book, Pisani talks about her work in the field as an epidemiologist, studying patterns of HIV infection in Indonesia, China, East Timor, and the Phillipines, and developing policies to combat it. The book is filled with conversations, both enlightening and troubling, with waria, heroin users, sex workers, and the employees of public health organizations, and ventures into methodone clinics, red light districts, and needle exchange programs.
But despite the diverse range of people and places Pisani comes into contact with, the book's most important idea is a simple one: outside of East and South Africa, most new HIV infections are contracted through the buying and selling of sex, unprotected, unlubricated anal sex, and the sharing of needles; however, most of the billions of dollars that governments and other organizations provide for prevention and treatment do little or nothing to target the groups most at risk.
Because, as Pisani puts it, there are no votes and no political goodwill to be gained by doing nice things for junkies, prostitutes, and gay men.
In the mid-1990s, money for HIV and AIDS research became plentiful, when it was feared that the disease would rampage through the general population (despite the fact that in most of the world, this wasn't the case). However, much of that money came, and continues to come, with strings attached. While Pisani lauds the Bush administration for actually putting the money on the table and persuading other governments to do the same, she is scornful of abstinence-only prevention programs and governments' refusals to fund needle exchange programs. In developing Christian and Muslim countries, it's much more difficult to achieve high levels of consistent condom use among at-risk populations because governments stand in the way.
She is equally frustrated by programs adopted to slow the transmission of HIV in Sub-Saharan Africa that target the disease as a "development problem," focusing on gender inequality and poverty. In truth, she says, HIV in Africa is spread because most people aren't circumcised, older men have sexual relationships with young women, spreading the disease across generations, and people tend to have "nets" of sexual partners, rather than "strings." Many Christian African governments don't want to talk about these sexual behaviors, and other organizations believe these ideas to be racist; however, many programs currently in effect on the continent will do nothing to prevent people from dying of AIDS for the sake of religious and political ideology.
It's tempting to go on about more of Pisani's arguments and observations, but I'll save the rest of those for readers. Instead, I should probably mention Pisani's writing style, which may put off the prudish or those who believe these are issues that should be spoken of with grim faces and finger-wagging. She's frank, foul-mouthed, and sometimes, funny. Also, it's important to remember that Pisani is concerned with public health, which is more concerned with national and global patterns than in individual cases. At times, this may seem impersonal and callous, but Pisani is not. Her in-depth work with at-risk populations and her obvious compassion for the individuals she works with should make that much clear.
Pisani doesn't flinch, doesn't judge, and is passionate about the collection of good, reliable data and the use of HIV/AIDS funding where it will do the most good - she's a scientist with a rock and roll heart.