Book Review: The Wisdom Of Whores Elizabeth Pisani
It's close to thirty years ago since British rocker Ian Drury had a hit with the song "Sex And Drugs And Rock And Roll". Somehow or other nobody had strung the three together in quite the catchy way he had before, and his little ditty's title caught more then a few people's imaginations. In those innocent days prior to AIDS and the "War On Drugs", it became the catch phrase of choice for a great many people to sum up what they needed to make them happy. That Drury might have been satirizing the rock star image with his song was lost on ninety per cent of his audience, who had latched onto the title as a lifestyle definition.
The world spins around and ten years later, in the 1980s, I couldn't read the obituary pages of my local paper without reading that a man of my generation had died of unknown causes, leaving behind special friends, but very rarely, a wife or parents to mourn him. AIDS was very much a mystery in those early days in the mid to late eighties, but even then we knew it was caused by sharing bodily fluids and the quickest way of catching it was through unprotected sex and sharing a needle. It was only a matter of time before it spread beyond gay men. Sex and Drugs were "very good indeed" no longer.
When the Canadian Red Cross came clean about not testing their blood properly and giving hemophiliacs infected blood, (and oh by the way if you received a blood transfusion between these dates you really should get yourself checked), the "innocent victim" syndrome in AIDS reared its ugly head. Just what the world needed - another way to stigmatize people who were dying because they had sex or shared a needle. The Christian right in North America had already labelled HIV and AIDS as the wages of sin, and being able to say they only have themselves to blame, while others are blameless, only added fuel to the pyre they were building to burn the sinners.
In the preface to her book The Wisdom Of Whores, Elizabeth Pisani says that when people ask her what she does for a living she cheerfully replies "Sex and drugs" as it's easier than having to explain to people that an Epidemiologist studies how diseases spread in populations. For ten year of her life, starting in 1996, Ms Pisani worked on the front lines of HIV/AIDs research looking for patterns in how the disease was spread, developing ways of curbing the spread of the diseases, trying to figure out how many people were potentially at risk, and of course dealing with the political fallout that always seems to accompany sex and drugs.
In the course of her work she has run police roadblocks in Indonesia carrying blood samples and used syringes, sat on street corners with prostitutes in the border towns of China and Tibet discussing the economics of their trade, worked with the transgendered prostitutes of Indonesia, argued policy with officials from the UN, the World Health Organization (WHO), Muslim Clerics, and brothel owners in Thailand. The Wisdom Of Whores are the conclusions she has reached after these ten years of field work about what works in the fight against HIV/AIDS and what doesn't work. These conclusions are backed up by not only her years of personal observation, but by the data she has crunched charting the growth of the disease and the effectiveness of the various means used to prevent it's spread in different countries and among different social groups.
One of the most frightening things about this book is, at the time it was being written, the amount of influence being exerted on HIV/AIDS programming by people with political and religious agendas. From Muslim Clerics in Africa and South East Asia saying that not using condoms proves how faithful you are, the American government going so far as prohibiting their staff from having access to research that proves the effectiveness of condoms in preventing the spread of sexually transmitted diseases (STD), to American policy that tries to prevent any agency, whether they receive American money or not, from advocating the use of condoms as a preventative measure; it's more important to these people that their view of the world is adhered to than the disease be prevented from spreading.
In spite of the statistical evidence that Ms. Pisani cites, that over 70% of the people who sign pledges vowing to abstain from pre-marital sex end up having pre-marital sex, the American government still preaches abstinence as the answer for preventing the spread of HIV/AIDS. The fact that the majority of these people also practice unprotected sex is even more damning. That those figures are from the US, and not a country with a flourishing sex trade, makes the whole abstinence argument even more spurious.
In spite of what any number of groups might want you to think, according to Ms. Pisani's research very few people are sold into the sex trade of South East Asia as slaves. It's more a matter of simple economics; a women can earn more in a half hour as a prostitute than she would for making 150 t-shirts in a sweat shop. If people are really so concerned about women in the sex trade maybe they should consider paying a little more money for their brand name t-shirts so these women have a viable alternative to make money to feed their families.
In all of these countries where condom programs have been implemented within the sex trade infection rates have been halved and continue to decline. The programs that work best are the ones like the one implemented by Thailand. The government allows the brothels to operate as long as the women working there use condoms, if they don't the government closes it down and the owner loses his source of income. By routinely randomly testing all the women working in the brothels for STDs the government is able to tell if condoms are being used. Not only has this helped prevent the spread of HIV/AIDS but it has also cut down on the spread of all STDs among clients, brothel workers, and all of their families.
The sharing of needles by intravenous drug users is of course the other big way that the virus is spread. In spite of this, resistance to needle exchanges as a means of prevention still runs high. Those who believe in the war on drugs are convinced that needle exchange programs encourage drug use and don't want anything to do with it. Yet statistics presented by Ms. Pisani shows that needle exchanges not only help prevent the spread of disease, they work to help people get off drugs. Two or three times a week they are in contact with social workers who can give them referrals to treatment programs and provide them support in quitting drugs and a good many of them take advantage of it.
The other big issue that Ms. Pisani raises is the need to balance treatment and prevention. While nobody wants to see anybody die when there are drugs available that could prolong their lives for as much as ten years, the problem is now that too much of the HIV/AIDS budget is being spent on treatment and prevention is falling by the wayside. As a result people are still being infected in spite of everything we know. Politicians are much happier when they can say they are giving money to treat pregnant women so they don't spread the disease to their unborn child, or to treat a child who was born with the virus, than they are in announcing money to help people who have sex and use drugs from catching it.
The Wisdom Of Whores is like a gale of fresh air being blown through the musty smelling bullshit that has surrounded the whole HIV/AIDS issue from day one. It's not just the holy cows of the right Ms. Pisani takes on either in her battle to save lives. Everything from peer counselling to confidential testing is put under her microscope for analysis; saving lives and preventing the spread of the disease is what concerns her not what people think is right. I'm sure this will get a lot of people's backs up, but it's hard to argue with her statistics about rates of infection.
It's hard to imagine a book about a subject as dry sounding as epidemiology being a page turner and entertaining, but Elizabeth Pisani has managed to do just that. She is irreverent, but never irrelevant; by turns angry, compassionate, and frustrated, she is a refreshingly human voice among so many speech makers. Sex and drugs might be taboo subjects for most people, but they are Elizabeth's bread and butter, and according to her they are at the root of HIV/AIDS. The Wisdom Of Whores paints as true a picture as possible of the fight against the spread of HIV/AIDS and where it stands today as you're liable to ever read. As well as the book you can also go the Wisdom Of Whores web site to receive even more up to date information and join in the ongoing discussion on how the world is doing in its fight to keep people alive.