The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS unknown Edition

If Michael Moore were to dress up in women's clothing and prowl through the red-light districts of Jakarta, we might get a book similar to "The Wisdom of Whores." But this author not only has Moore's street smarts and a lively writing style, she also has a PhD in infectious disease epidemiology. Elizabeth Pisani knows whereof she speaks, because she has spent years on the streets and in the dingy bars where AIDS futures are traded.

"Whores" is one of a rare species of book such as Upton Sinclair's "The Jungle" or Jessica Mitford's "The American Way of Death" that has the power to reform an industry. In this case, the author exposes the AIDS prevention industry that sprang up when First World governments started to shovel money into the vital struggle against the HIV retrovirus. Or at least, that's where they should have shoveled it. If you think that the U.S. Government's emphasis on chastity over latex is a great way to spend your tax dollars, you definitely need to read this book.

I was particularly interested in learning why the AIDS epidemic in Asia has not taken off with the same alacrity as it did in South and East Africa.

Elizabeth Pisani may resemble one of Dante Gabriel Rossetti's ethereal Pre-Raphaelite models, but she talks about sex, drugs, and AIDS in the language of her subjects: the sex workers of Indonesia, China, East Timor, and Africa (foreskin soup, anyone?). She describes how governments are wasting billions of AIDS dollars on "schoolgirls and housewives and Boy Scouts" when they should be concentrating on preventive measures for the people who are actually at risk for this deadly disease: "junkies and gay guys and the people who buy and sell sex."

If you are someone who believes that "junkies and gay guys and the people who buy and sell sex" are getting what they deserve, this author has a message for you, too: remember who is infecting the housewives, Boy Scouts, and even the unborn children. The HIV-positive carrier could be your boyfriend, your sister, or your grandchild. Is there anyone in this 21st century without a friend or relative who is infected with this deadly retrovirus?

Some people may object to the frank language of `Whores.' Others may object to its message that condoms will do more to limit the spread of AIDS than misguided attempts at abolishing the sex trade. Most of us will have our eyes opened on what really needs to be done with our tax dollars in order to mitigate the worldwide AIDS crisis.

Review copy supplied by author

Elizabeth Pisani's The Wisdom of Whores - Bureaucrats, Brothels and the Business of AIDS is a great book (along with a great website). Elizabeth Pisani is an epidemiologist with years of experience working on HIV/AIDS (or sex and drugs, as she puts, which sounds a lot, well, sexier) at a variety of agencies, including UNAIDS. The book is the story of her frustrations at the way the international community, national governments, NGOS and AIDS activists have dealt with the epidemics, as well as her hopes in some of the progress made.

I got interested in the book when I read an interview Pisani gave to the Guardian. The interview kinda billed the book as a controversial work where Pisani would be the mean lady who said people got AIDS because of their stupid behavior and not enough was being done because of political correctness. So, I was ready to get really pissed off with the book. That has not been the case at all.

Elizabeth Pisani is a scientist and that perspective is pervasive in the book. That's a good thing. I much prefer sober, "just the facts" perspective to touchy-feely stuff. Actually, one of the main frustrations that Pisani deals with in the book is the fact that AIDS had to be made about innocent wives and children for the international community to gear into action, as opposed to the real populations at risk in most parts of the world (except Africa, and she shows that even in Africa, the innocent wives and children trope does not work, as the data show): drug injectors and people who buy and sell sex.

To me, precisely because the book is data-driven, it was not controversial. My reaction was more, "well, if that's what the data show, so be it." But also, I think, the book was billed as controversial because Pisani calls things what they are: penises, receptive or insertive anal sex, etc. and she does spend a lot of time describing her study in red light districts of Jakarta and other (mostly Asian) place. She discusses the brothels, the warias (transgendered male prostitutes) and rent boys, the drug injectors. She does spend a lot of time describing that world that a lot of people would rather never hear of: the stigmatized, the marginalized, those we can safely ignore and those that don't get politicians votes come election time. Doing nice things for whores and junkies carries no political rewards. Doing things for innocent wives and children does. So, that's what has been done with HIV/AIDS and this has been a tragic mistake.

But these descriptions are unvaluable and fascinating because we never read about them. If you read about HIV/AIDS, you will read a lot about Africa (which does make sense since the high rates of infection in the general population are to be found in Eastern and Southern Africa). The problem is that the African patterns of infection have been assume to apply everywhere, especially Asia, where that is just not the case. So, the solutions and programs suggested are inadapted.

The programs needed in Eastern and Southern Africa are not those that are needed in Asia. In these parts of Africa, AIDS does affect the larger population but that's just not the case in Asia where most of the solutions described by Pisani involve programs to distribute condoms, lubricants and clean needles. It is also one of Pisani's other frustrations: we know how HIV is transmitted (biologically, that is), we know the types of behavior most likely to facilitate this transmission, so, we know what kind of prevention is needed. And yet, there is too much focus placed on treatment, rather than preventing people from getting infected in the first place.

Another thing that definitely comes through as Pisani tells the story of her peregrinations through Jakarta, trying to collect good data to design good public health policy, is that, whether she likes it or not, she comes across as someone who really does care about all the junkies, whores and warias she meets along the way. Her scorn is reserved for other people: UN bureaucrats who do not want to call things what they are because of who might get offended, religious conservatives who lie and work their hardest to prevent good prevention or good policy. But don't think the liberal crowd, the NGOs or activists are off the hook either.

Pisani has no patience for distraction, a major one being that AIDS is a gender / development / poverty issue. Pisani shows that this liberal idea, favored by a lot of NGOs and UN agencies and other donors is a distraction. First, it's a distraction because first, you may have the causality wrong (AIDS causes development / gender issues rather than the other way around), second, as shown in the book, even in Africa, that's not always the case, and third, because, again, that gets in the way of common sense prevention which should be the main focus, along with treatment for the already infected population. But again, focusing on women and children makes the AIDS issue more palatable to donors than those filthy whores, junkies and fags, so, Pisani and her colleagues at the AIDS Mafia, as she calls them, played that game too. After all, once you have the money, you can still get stuff done.

And, of course, I particularly enjoyed the chapter blasting the Bush administration and its faith-based initiatives and PEPFAR (President's Emergency Plan for AIDS Relief). Although she does credit the Bush administration for putting money on the table, Pisani makes mince meat of the Bush and his religious nuts crowd for their hypocrisy and nonsensical attitude. She deals swiftly with Virginity Pledges and the creepy Virginity Balls and the whole family values crowd.

Finally, Pisani has also no patience for the workings of the international community and civil society, the demands that donors put on local activists, the circuits of money distribution which end up sometimes producing ridiculous policies: like having an AIDS program in East Timor when there is no AIDS problems in East Timor (although there are other problems that would need funding but don't get it).

Again, let me state: when was the last time you read an epidemiology book that was a great read, straight to the point, data-based, sometimes fun, but always informative.

Dr. Pisani is a rarity in that she is a scientist who can write! She is a former journalist turned epidemiologist (aka "epi")working in AIDs research amd prevention. Her book will interest not just those readers concerned with AIDs, but anyone who wants to understand the effect politicians and bureaucrats and competing NGOs(Non-government orgaizaions) have on public health. Often only scientists and academics can grasp the process and explanation of scientific research. Dr. Pisani explains it so clearly that the general reader will understand as well. However, she hasn't "dumbed down' the scientific research process and data analysis. Through out this excellent book she shows a deep respect for the intelligence of her reader. No matter what opinion someone has regarding AIDs and its victims, this book will help improve understanding of the disease, its transmissions, the risks of being infected, and how its spread could be stopped. The title may be shocking, but sometimes it take a shock to get many of us to pay attention. Buy this book! Once you start reading you will not put it down until you reach the final page!