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

I read a lot, on a wide variety of topics. If it has words on it, I'll try to read it, even if I _don't_ know the language, I'll try to decipher it. But some books are much more rewarding than others, and this is one of the most rewarding books I've ever read. The other reviews cover the topic well: she's a great writer, a person who really cares about people and not just people who are like her, a scientist who can understand numbers and make them make sense to others. She has a wide-reaching understanding of how AIDS is transmitted, and how that transmission is partly biologically determined and partly culturally determined. And she can convey that complex and detailed understanding in a simple way. Repeatedly, so if you miss it the first time, you get a lot of additional chances. And with hilariously shocking illustrative stories, so there's no remote chance of boredom ever setting in. I know there's no way she's going to slog through bureaucracy for a second cause -- that would be unfair to ask of anyone. But I hope global warming/climate change/peak oil/etc. gets someone half as brilliant as Pisani. Hopefully several someones.

For sheer accuracy of synopsis, maybe "The Wisdom of Whores"'s subtitle ought to be "Practical Epidemiology, What We Know About Solving the AIDS Crisis, and How the Politics of International Aid Complicate Matters." Though Pisani probably wants to sell a copy or two. This is one of the few books I've read that actually lives up to its jacket blurbs. One author describes it as not only a work of science, but also a page-turner. And indeed it is. Pisani holds a Ph.D. in epidemiology, and you can tell from reading The Wisdom of Whores that she has the chops to do serious data analysis. It's data analysis in the service of a practical end, namely figuring out the most efficient ways to stop AIDS. Pisani has been on the ground interviewing prostitutes and junkies for a couple decades now, so she's learned a bit about how the disease actually spreads. Part of the answer is just common sense: HIV spreads when an infected person's blood comes in contact with an uninfected person's blood. When heroin users share needles, the risk of HIV's spreading rises. Unprotected sex is riskier than protected sex. Unlubricated sex is riskier than lubricated sex, because the risk of causing tears is higher. Uncircumcised men are at higher risk than circumcised men. Prostitutes and their johns are at higher risk than non-prostitutes, because they have more partners. This much should be common sense; the fact that this common sense often doesn't translate into policy is where the "bureaucrats" in the subtitle come in. The Bush administration and many other nations have changed the conversation: we don't talk about the actual mechanics of sex and drug use, in part because prostitutes and drug users are considered wicked, and it helps no politicians to aid the wicked. From a public-health perspective, most of our effort ought to be focused on the populations that are most at risk: addicts, gay people, and prostitutes. But that doesn't sell. What sells is to talk about "neutral" topics: pretend that consumers of prostitution come home to their innocent wives and unwittingly give them the disease, which then spreads to their kids. When you frame the issue as "AIDS hits everyone," surely you can get votes. Likewise with international aid: if you tell your voters that "poverty and gender disparities" cause AIDS, you can sidestep the icky topics of sex and heroin injection. Once the money flows, there's a great risk of corruption and waste. Fortunately, Pisani tells us, there are a lot of people on the receiving end of that money who are really trying to do right by the world's taxpayers. And there are organizations like the Bill and Melinda Gates Foundation that seem to disburse funds more efficiently and measure programs' effectiveness better than a lot of governments do. And the governments are learning from their mistakes, in no small part because the epidemiologists on the ground are pushing back on them. Pisani never takes the step that a lot of libertarian fanatics d

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 Easte

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!

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