Posts Tagged ‘aids’

Elizabeth Pisani was there at the beginning. A trained epidemiologist, Dr. Pisani has spent years interviewing hookers in seedy bars, chatting with junkies in train stations and exhorting bureaucrats to take smart steps to stop the spread of HIV/AIDS. In The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, Pisani gives a whirlwind, first-hand tour of the uncomfortable realities of the global HIV epidemic.

While Pisani certainly knows her science, this is not a academic work. Often, reading it seemed more like you were listening to the author rant about boneheaded policies over a couple beers. Her writing is equally informative, hilarious and disconcerting.

The millions infected with HIV/AIDS did not need to be; there are well-established methods to prevent and treat the disease, but they require inconvenient truths. Rare is the politician who wants to admit his country has a heroin problem. Even rarer is the politician who will then do so publicly, repeatedly and provide clean needles so the virus doesn’t spread. The same wrongheadedness is found in donors, NGOs, ministries of health and civilians, and Pisani lambastes them in equal, deserved parts throughout the book.

The book might have been called “Confessions of a AIDS Activist,” but Pisani points out it is curious that “cancer activists” or “dengue fever activists” do not exist. A large reason for this is because HIV/AIDS disproportionately infects the marginalized in society – gays, prostitutes and drug addicts. As public health experts began to realize that this disease was going to tear through society, they had to convince politicians and the public that the disease mattered to them, as well. This took the form of “beat ups” where data was described in simple, dramatic terms to overcome the realities of politicians who care more about votes than lives. The sad fact is, this still needs to be done in many countries.

Dr. Pisani is painfully honest and opinionated. Her iconoclasm is aimed at commonly held beliefs like “AIDS is a development problem” and “the more people working on this, the better.” She dedicates an entire chapter to breaking down the religious leaders’ arguments that have led to idiotic, non-scientific policies and contributed to the death of those with AIDS. For example, George Bush’s “President’s Emergency Plan For AIDS Relief” has been heralded as one of his shining foreign policy achievements; however, the influence of conservative Christians has propagated ineffective abstinence only plans and severely curtailed needle exchanges. Although he deserves credit for throwing a lot fo money on the table, “…by law, 20 per cent of the PEPFAR money must be spent on HIV prevention, and one-third of that is specifically allocated to programmes that do nothing but push abstinence until marriage. That is US $1.06 billion to fund foreign programmes that have a failure rate of 76 per cent…”

The reality of HIV/AIDS is far more complicated than a brief review or single book can do justice. But the take-away fromm Pisani’s account is that although the biology is easy and the epidemiology well-known, the answer to how to solve this problem requires patience, collaboration and smart policies. It depends on the specific contexts in each society, city and brothel.

Pisani’s blog is here.