Wisdom of whores – Bureaucrats, brothels and the business of AIDS

By Elisabeth Pisani
ISBN 978 1 84708 076 9
363 pages
Granta Publication, current edition: 2008
Priced €9.99

Sex and drugs, cookbooks for UNAIDS and foreskin soup; not something you encounter in every book you read. Nonetheless, these are elements from Elisabeth Pisani’s 10-year long experience as a researcher in the field of HIV/AIDS. In Wisdom of whores: Bureaucrats, brothels and the business of AIDS Pisani states that HIV can be shut down everywhere, except sub-Saharan Africa. She describes that this could be achieved in a few simple steps, saving billions of dollars and countless feel-good programmemes and projects that do not make much of a difference. In her book, Pisani shares somewhat controversial stories, her honest opinion about everything that is wrong with HIV/AIDS programmemes, and humorous personal experiences from everyday life as a field epidemiologist in Indonesia.

Pisani describes how challenging it is to perform field research (“anything that can go wrong, will go wrong”) and uses her own stories to explain this. “In HIV research you’re going from brothel to gay bar asking about behaviours that are often illegal or embarrassing and collecting specimens to test for an unspeakable fatal disease in countries with erratic vigilante movements and an irregular power supply.” One can imagine the countless difficulties. She describes how practice in the frontline of sex and drugs can be so different compared to the theories and study designs that are developed in offices in Geneva or elsewhere far from field realities. Her research participants, for example, often didn’t fit into the pre-fabricated boxes (e.g. male prostitute, drug injector, client of female sex worker), but were rather all at the same time, or none at all.

Billions of dollars have been spent on scientific evidence collection and “common sense” projects in the field of HIV/AIDS, but it does not seem to make much of a difference. HIV/AIDS remains a major global health burden to this day. What is the problem, and where did all that money go? As Pisani states, “hard science” is not enough. “You work in public health because you want to save a lot of lives. If you’re going to do that effectively, you cannot stop at the perfect study design, or even at the publication of your perfect paper in The Lancet or the New England Journal of Medicine. […] Something that works in the lab but doesn’t work at the ballot box might be good science, but it is unlikely to get translated into good public health. You have to do good science, and then sell good science.” She argues that science does not exist in a vacuum. “It exists in a world of money and votes, a world of media enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religions and political ideologies and all the other complexities of human life.” Her field experience has taught her that ideology and too much money (and not lack thereof, as we are often made to believe!) are the major obstacles to sensible HIV prevention and actually doing the right thing. These two factors often drive important choices, from local prevention strategies to international funding decisions. Many parties share the blame for the inefficient use of funding. An absurd example of squandering of taxpayer’s money is from East Timor. After becoming an independent nation in 2002, the country received US$ 2 million to fund its HIV programmemes, although only seven people had tested positive for HIV at that time.

In this thought-provoking book, Pisani shares her honest and critical look at the state of HIV/AIDS, while remaining respectful to all parties involved. Furthermore, her witty writing style and amusing examples have created an easy read, recommended to everyone who is open to rethinking the current approach to tackling HIV/AIDS.

Something that works in the lab but doesn’t work at the ballot box might be good science, but it is unlikely to get translated into good public health