This is an utterly fascinating book. I must admit that it's been growing on me since I read it, the arguments and language reverberating in my mind. Elizabeth Pisani writes with enormous verve and acerbity, her prose alive with anecdote and metaphor. There is, to be sure, a certain adolescent touch, delighting in naughty words and vivid sexual description, but all of that is forgiven in the sweep and force of the narrative. The Wisdom of Whores is a great read.
The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS
, by Elizabeth Pisani, Viking Canada, 372 pages, $35
The title is meant to convey the variety of sexual experience and the savvy that attaches to it. The text is replete with references to "prostitutes, rent boys, pimps and clients ... addicts, cops and rehab workers." The chapter on Indonesia alone is an astonishing foray into the world of female, male and transgendered sex workers, all of them imparting wisdom on AIDS. Even in the preface, Pisani talks of a trip through several Asian countries where "I encountered a world of women with penises who sell anal sex to men who are completely heterosexual. I found men who buy sex from women and sell it to men. I found heroin addicts who fly airplanes and Muslim fundamentalists who run protection rackets for brothels."
Yes, some of it is designed to shock. But as the pages turn, the interlocking universe of bureaucrats and sex work and NGOs and agencies yields fascinating insights into the pandemic. It would be a great mistake to discard Pisani because of the bizarre or the uncomfortable. There are many home truths to be found in the most unlikely of places.
He book is also a compelling challenge to most of the orthodoxy that clutters the world of HIV/AIDS. Although the great majority of material is drawn from Asia (primarily Indonesia, where the pandemic is relatively small), rather than Africa (where the pandemic is a nightmare), Pisani still manages to wander the landscape of controversy.
On the issue of abstinence, she's appropriately savage about the perverse policies pursued by right-wing religious groups and the Bush administration
Pisani is a journalist turned epidemiologist. She's worked or consulted for a kaleidoscope of international organizations in a great many countries, allowing her to speak with first-hand knowledge, and to make a number of frontal assaults on conventional wisdom. Most important, perhaps, is her exasperated assertion - gaining increasing credibility in the argumentative world of AIDS - that the international response has been wrong-headed: The assumption that a generalized pandemic sweeping through a country's population, as in Southern Africa, would necessarily show a similar pattern in a country like India or China or Indonesia just isn't true. The pattern outside of Africa is a series of concentrated epidemics among "high-risk groups," men having sex with men, or drug injectors or sex workers, and there is very little evidence that the virus will infiltrate the broader population.
Now nothing is absolute in the world of AIDS, but Pisani's argument, if even marginally accurate, has huge implications for the response. If the resources, especially for prevention, are applied to a population as a whole, where the risk of contracting AIDS is minimal, rather than targeting the high-risk groups, then not only is money wasted, but HIV spreads wantonly through these hard-to-reach categories.
There's just no question that the hotshots of the AIDS establishment have resisted Pisani's thesis (also advanced by others of repute) for many a year. It's monumentally irresponsible. When the head of HIV/AIDS for the World Health Organization recently made statements much in line with those of Pisani, he was forced into a humiliating retraction by vested interests in other parts of the UN system.
